The health of the skin

THE HEALTH OF THE SKIN

\

METHUEN'S HEALTH SERIES

Edited by N. BISHOP HARMAN, M.B., F.R.C.S.

Fcap. Bvo, is. net.

THROAT AND EAR TROUBLES
By MACLEOD YEARSLEY, F.R.C.S.

HEALTH FOR THE MIDDLE AGED
By SEYMOUR TAYLOR, M.D.

THE CARE OF THE TEETH

By A. T. PITTS, M.R.C.S., L.D.S.

THE EYES OF OUR CHILDREN

By N. BISHOP HARMAN, M.B., F.R.C.S.

THE CARE OF THE BODY
By FRANCIS CAVANAGH, M.D.

THE HEALTH OF THE SKIN
By GEORGE FERNET, M.D.

THE PREVENTION OF THE COMMON COLD
By OLIVER K. WILLIAMSON, M.A., M.D.

HOW TO LIVE LONG

By J. WATSON CARR, M.D.

THE HEALTH OF
THE SKIN

BY

GEORGE FERNET, M.D.

METHUEN & CO. LTD.

36 ESSEX STREET W.C.

LONDON

First Published in igib

CONTENTS

CHAPTER I
INTRODUCTORY

PAGE

Its origin from the developmental point of view — Con-
nexions with the other organs of the body . . 1-4

CHAPTER II
ANATOMY 'AND PHYSIOLOGY

Architecture — The epidermis or scarf-skin — The corium
or true skin — The blood - vessels — The nervous
elements — The fatty layer under the skin — The
hairs and fatty glands — The sweat apparatus — The
vitality of the skin . . . . . . 5-15

CHAPTER III
PHYSIOLOGICAL AND MORBID VARIATIONS

Hairiness — Excessive dryness of the skin — Sweating
and perspiration — Odours of the skin — Colour —
Variations in texture — The skin and the nerves —
Parasites — Morbid conditions — Malformations — The
body temperature — Pigment — Exposure to the sun's
rays — Birthmarks 16-33

36442;^

vi THE HEALTH OF THE SKIN

CHAPTER IV

TOPOGRAPHICAL VARIATIONS

PAGE

Baldness — The scalp — The skin of the face — The eye-
brows and eyelashes — The ears — The scalp and hair
— Morbid conditions — The neck — The skin of the
body — Shingles ....... 34-48

CHAPTER V
GENERAL HYGIENE AND BATHS

Baths among the Greeks and Romans — Mediaeval times
— Odours of the skin and ventilation — Effect of food
and drugs on the odours of the skin — Scents — The
hands and feet — The skin of the new-born . . 49-64

CHAPTER VI

CLOTHING

Infants — Wool, cotton, and silk — Dress of women —
Hats — Garters — Foot-gear — Corsets — Gloves —
Beds 65-71

CHAPTER VII
SOAPS

Origin of soap — The soap of the Gauls — Greeks and
Romans — Manufacture — Various kinds of soap —
Sponges 72-75

CHAPTER VIII
COSMETICS OF THE SKIN

Antiquity — Romans — Fashion — Rouge — Patches —
Massage — Danger of paraffin injections under the
skin . 76

CONTENTS vii

CHAPTER IX

THE HAIR

PAGE

Fashions in ancient times — Hair-dyes — Dangers of
some of them — Henna — Inflammable applications —
Loss of hair — Some morbid conditions of the hair
— Ringworm of the scalp — Parasites — Epilation
— Hygiene of the scalp — Hairdressers* shops —
Greases — Eyebrows ...... 81-93

CHAPTER X

TATTOOING

Variety in patterns—Dangers connected with tattooing
— Cleanliness of instruments — Removal of tattoo-
marks 94-95

CHAPTER XI

THE NAILS

Description — Variations in the appearances of the nails
— Growth — Cosmetics — Care of the nails — Their
preservation — Identification by means of finger-
prints— The toe-nails 96-103

INDEX 105

THE HEALTH OF THE SKIN

CHAPTER I

INTRODUCTORY

IT is a common delusion to imagine that the skin
is a simple membrane or covering drawn over
the muscles and bones of the body and of very little
importance as compared with the nerves and blood-
vessels, to say nothing of such organs as the liver
and lungs for instance. The truth is that the skin
is a vital, complicated structure. In its develop-
ment from the fertilized human egg, it may be first
noted that the skin arises from the same layers of
cells in the embryo as the brain, spinal cord and
nerves generally. Indeed the skin is a wonderful
fan-like expansion directly connected with the
central nervous system, and is like the eye and ear
an organ of sense, viz. the sense of touch.

The skin or integument of the body may be aptly
compared to an admirable casing, which not only
separates us from the surrounding atmosphere and
the earth on which we have our being, thereby
making us the individuals we are, but it also acts as
an outpost of scouts as it were to warn us of outside

2 THE HEALTH OF THE SKIN

conditions and protect us from dangers. This was
quaintly expressed by a seventeenth-century writer,
Phineas Fletcher, — in a poem on the human body
called ' The Purple Island/ in which the skin is
described as

'. . . that round spreading fence,
Which like a sea, girts th' Isle in every part ;
Of fairest building, quick, and nimble sense,
Of common matter, fram'd with special art;
Of middle temper, outwardest of all,
To warn of ev'ry chance that may befall :
The same, a fence and spy ; a watchman and a wall.'

The skin responds to changes of temperature, to
pressure, and in ordinary states of health, allows us
to distinguish variations in the amount of heat and
cold in objects coming into contact with it. The
skin is a great tactile sense-organ directly linked
up with the brain. Moreover the skin in this way
co-operates with other sense-organs, such as the
eye for instance. Thus it is the child gradually
gains experience of surrounding bodies, not only by
seeing them, but by feeling them too. This tactile
sense together with the impulses from the other
sense-organs slowly build up consciousness in the
growing child.

The relations of the body-covering to the heart,
lungs, kidneys and so forth are constantly being
brought into play. Thus hot applications by flush-
ing the skin and stimulating the nerves may relieve
the heart. Cold water suddenly coming into contact
with the skin makes one catch one's breath. Cold

INTRODUCTORY 3

water to the head as at the end of a shampoo activates
the respiratory movements. In cold weather again,
the fact that the blood-vessels of the surface become
contracted and the parts pale, leads to extra activity
of the kidneys. Touching a hot metal immediately
leads to involuntary action of the muscles through
messages sent to the central nervous system which
are at once reflected by nerve messages to the muscles
connected with the part endangered. In a similar
way too, a baby will support its weight by grasping
a stick or branch. Flicking the face with a wet
towel or dashing cold water on it as in faints acts
on the nervous system through the bulbous upper
end of the spinal cord close to the brain, the medulla
oblongata as it is called. Counter-irritation by means
of mustard leaves and mustard foot-baths, as also
tickling the nostrils with a feather and ' firing ' the
skin with a cautery, act in a similar way. Among
the Chinese, acupuncture or driving needles of
different sizes and lengths into the skin is a common
method of treatment. They are also fond of apply-
ing caustics. One way they have of cauterizing is
to burn the flowers of the amaranthus on the skin.
Putting a cold key down the back for bleeding of
the nose depends on the same idea. Even fanning
the face makes a difference to the mental processes.
The estimation of weight by holding an object
in the hand and testing the smoothness or otherwise
bf a surface by passing the fingers over \t are further
examples of the importance of the skin in everyday
life. Though as to weights and resistance to pres-

4 THE HEALTH OF THE SKIN

sure other factors, such as the muscles and joints,
come into play as well. It is through this tactile
sense that the blind are able to read the Braille
relief type and get ideas about solid bodies and
surfaces.

Further than this, emotional conditions may
operate as a result of ideas arising in the brain and
express themselves in the skin, such as blushing
with shame or from timidity and flushing with plea-
sure. Or contrariwise, fear and terror acting on the
superficial blood-vessels lead to pallor of the skin
and to the breaking out of a cold sweat.

We have mentioned the eyes in connexion with
the skin. Their relationship is very close, for in the
life-changes, which take place in the human indi-
vidual at an early period, the front parts of the eye
arise from a pushing in of the skin from the surface,
thus meeting the nerve elements which are pushed
out from the primitive brain. In this manner the
two parts together form the organ of vision. The
same may be said of the ears and other orifices. But
in so doing the skin takes on special appearances,
which serve to distinguish them from the general
body-covering. Moreover, if we look at the integu-
ment, we will at once notice that the skin varies in
certain ways from part to part of the body.

CHAPTER II

ANATOMY AND PHYSIOLOGY

IN this place, we may well consider the actual
structure of the skin in a more detailed manner.
The skin consists of two parts : the epidermis, which
forms the surface and protective layer of the body,
and the true skin or corium or cutis immediately
beneath. The former sends cone-like prolongations
down into the true skin, whereas the latter sends up
cone-like projections, the two fitting together and
forming one structure, except in diseased conditions.
When the skin is abraded, as in barking the shins
for instance, the epidermic layer (or cuticle and
scarf-skin of ordinary language) is separated from
the underlying bleeding true-skin or corium. The
epidermis is soft and moist at its growing point of
juncture with the true skin. As it grows, its com-
ponent cells become harder and flatter as they rise
to the surface of the body, where they become horny.
In this way a waterproof covering is formed, which
prevents fluids from without soaking in and the
fluids of the corium escaping outwardly. From
this rough description it will be readily understood
how important is the part played by the outer cover-
ing of the skin or epidermis. When its superficial

6 THE HEALTH OF THE SKIN

or horny layers axe removed either physically or as
a result of destruction by caustic applications and
irritating fluids, or again shed rapidly as in acute
inflammatory diseases of the skin, oozing takes
place from the unprotected surface, as in the well-
known example of ' weeping ' eczema as it is popu-
larly called. In burns of a certain degree, blisters
form as a consequence of the escape of fluid beneath,
which either raises the epidermis bodily in a dome-
shaped manner or splits it up in layers. In bad
burns, that is of a high degree, the epidermis is
destroyed leaving the naked corium beneath. It is
this which makes this class of burns when extensive
so dangerous to life, owing to the shock to the general
.nervous system, and which moreover takes them
long to heal and leaves disfiguring and unsightly
scars behind. I think it right to say here how
foolish it is to dress people up in wool as is often
done at Christmas and other gatherings, for if the
wool catches fire by some unlucky accident the results
may be fatal, or if not, the scarring of the face espe-
cially may be very serious and disfiguring, to say
nothing of injuries to the eyes. In the case of a
young woman, who came ultimately under my care
for the results of an accident of this very kind, the
scarring stretched round the face from ear to ear,
including the region round the mouth. But ' against
stupidity, the gods themselves fight in vain/ so
there will be further cases recorded from time to
time.

An insensible shedding of the horny layers of the

ANATOMY AND PHYSIOLOGY 7

skin is constantly taking place, what time fresh layers
of horny cells are being formed from below. In
some animals this moulting takes the shape of a
complete shedding of the epidermis as in snakes.
In frogs, shedding occurs in irregular shreds. The
moulting of feathers in birds is well known, and in
dogs the coat sheds many hairs at times. In deer,
changes occur in the horns and antlers, as anyone
can see for himself at the Zoo or in Richmond Park.
The changes observed in the skin of the drowned
are due to the soaking of the epidermis combined
with putrefaction.

The importance of the epidermis in its develop-
ment from the outer layer of the original simple
structures into which the egg divides at an early
period of its existence and its intimate connexion
with the nervous system has already been touched
upon. But it is further related in origin to the
covering of some parts of the mouth, nasal passages,
and also of the rectum and generative organs.
Moreover, in its development, the epidermis arises
from the same original cells as the enamel of the
teeth.

The true skin, derm or corium is the important
part of the skin containing as it does blood-vessels,
both arteries and veins, lymphatic channels, and
nerves, all held in place by a framework of connec-
tive tissue, which is itself made up of various bundles,
some of them elastic. As time goes on, the skin
proper loses its succulence and elasticity, and then
wrinkles appear. The elastic constituents resist

8 THE HEALTH OF THE SKIN

extension, and strips of skin will bear weights up to a
certain point, beyond which they lose their powers of
rebound, as in the case of over-stretched rubber bands.

The blood-vessels form two parallel systems, the
deeper one at the lower limit of the true skin being
made up of larger arteries and veins than the super-
ficial one lying just below the epidermis, the latter
sending loops of small arteries and veins into the
cone-like projections of the corium we have just
alluded to. The two systems are connected up by
arteries and veins, which come from the deeper
system. Nor must we here omit to mention the
blood itself which circulates in the vessels. The
lymphatic channels permeate the true connective
framework and serve to nourish the skin. They
play a part in morbid and inflammatory conditions.

The curious notions of school-children as to the
skin are well exhibited in the following examina-
tion answer : ' We have an upper and a lower skin.
The lower skin moves all the time and the upper
skin moves when we do/ This answer requires
some looking into. That ' the upper skin is called
eppederby and the lower skin is called derby ' is
rather sporting.

The fact that the skin is vascular has led empiri-
cally to the employment of counter-irritation and
poulticing to relieve congestion and inflammation of
underlying organs. The action of the mustard-leaf
in this way is well known. In the old days, cup-
ping was a common procedure, which under another
name has been revived in an improved manner in

ANATOMY AND PHYSIOLOGY 9

the actual treatment of certain skin conditions.
Cupping was either dry or wet. In the latter there
were fine lancets in the cupping-glass which were
released by a spring or trigger in order to let blood
from the skin by scarification, or scarification was
done first and the cupping-glass applied afterwards.
Venesection or letting blood from a vein was also in
common use in bygone days. This was done at certain
times of the year in the sound as a matter of routine
and no doubt it was often beneficial in the full-bodied
and plethoric. In the sick, blood-letting in this way
was abused and frequently improperly employed. In
Le Sage's novel ' Gil Bias/ the character of Dr. San-
grado was intended as a satire on what obtained at
that period. He treated all his patients without
exception by bleeding and making them drink
quantities of water. Gil Bias, his factotum, followed
in his footsteps and had to disappear very hurriedly
after treating a great dignitary of the Church in this
way. Howbeit, there is no doubt that in certain
circumstances bleeding, or phlebotomy as it was
called, is very useful. But the lancet of our fore-
fathers has gone out of fashion. In Tunis some
years ago I noticed a sign over a shop intimating
that the owner was a barber and phlebotomist.
The brass sign that still dangles at the door of
barbers' shops on the Continent was the dish that
received the blood and the barber's pole now seldom
seen, with its red and white stripes, was the symbol
of the staff the customer firmly grasped in his hand
to make the vein of the arm stand out for the lancet.

io THE HEALTH OF THE SKIN

Leeches have largely gone out of fashion with us,
but there is no doubt they may be of use in certain
circumstances. They leave a tri-radiate mark on
the skin.

If we now turn to the cutaneous nervous elements
we find they are of an extremely delicate structure.
It is they that make the skin an organ of sense. In
some parts, as in the finger tips, the nerve elements
terminate in complex minute bundles, which make
it possible for the hands to carry out not only the
hundred and one things which come our way in our
daily lives, but to do the fine work of the artist,
thus ensuring precision of movement in combina-
tion with the organs of vision and of hearing, and
the muscles, as in the painter and the musician.
Moreover, the nerves of the skin act on the blood-
vessels by contracting them and making their calibre
smaller. On the other hand, interference with their
action leads to vascular dilatation, hence congestion,
the first stage of inflammation. As already stated
the skin is linked up with the nervous system gene-
rally, and with the various nerve centres which act
on the breathing, the circulation, and on the func-
tions of the bowels and of the reproductive organs.

The sensitiveness of the skin led to a horrible form
of torture in the old days, i.e. flaying alive. The
soles of the feet are very sensitive as every one knows.
Punishment by the bastinado as among the Turks
is a refined mode of punishment. In certain con-
ditions, areas of skin may become insensitive, when
even sharp pricks are not felt. In mediaeval times,

ANATOMY AND PHYSIOLOGY n

when individuals were supposed to be possessed of
devils, these insensitive parts were sought out by
means of sharp-pointed instruments and when found
were considered to be positive evidence of such
possession.

About the rounded and fleshy parts of the body,
the skin rests on and is connected with a layer of
fatty material, the adipose tissue, which forms a
cushion. The fat is specially well developed about
the abdomen, the buttocks, thighs and breasts.
Among the Hottentots the abnormal development
of fat about the buttocks is a racial characteristic.
This steatopyga is well exemplified in the Hottentot
' Venus/ a model of which exists in the London
College of Surgeons* Museum.

But this is not all ; there are also important skin
appendages to be considered. They are the hairs
and fatty glands, the sweat apparatus and the nails.

As to the hairs and fatty or sebaceous glands, they
pervade the surface of the body in varying propor-
tions. They form with minute muscles the pilo-
sebaceous system. The hairs arise from the outer
layer of the skin, the epidermis, and are fed by vas-
cular loops from the true skin at their lower end. The
root-part of the hairs dips into the fatty layer sup-
porting the skin of the body generally, except in
parts devoid of fat. The hair itself is as we have
said nourished by a loop of the small arteries and
veins previously described and grows in the hair-
follicle or tube, which goes through the corium and
epidermis to reach the surface. Connected with the

12 THE HEALTH OF THE SKIN

hair is a fat-gland, which opens into the hair-follicle
or tube and lubricates the hair which is inserted at
an angle. Working on the lower part of the hair
is a delicate strand of muscle-tissue, on the same
side as the fat-gland. When this small muscle
comes into action, the hair is made to stand on end.
This is the mechanism of goose-skin on the smooth
parts of the body that look hairless, but which are
not strictly so, for they present a fine downy growth
which differs very much from the long and coarse
hairs of the scalp, face, armpits and other parts : —

c Upstanding then like reeds, not hairs.3

There is a certain set of the hair on the scalp,
which varies about the crown of the head in different
individuals, forming circles and whorls.

In addition to the foregoing structures, there are
the sweat-glands. These are also appendages of the
epidermis. These sweat-glands are made up of
coils or reservoirs in the parts below the true skin
or corium. They discharge their fluid contents by
means of a fine tube which zig-zag or corkscrew
fashion finds its way through the corium and epidermis
and has an outlet or sweat-pore on the surface of the
skin. These coils are also under the dominion of
nerve filaments and the state of the blood-vessels.
Normally a small amount of quiet perspiration goes on,
which is increased by exertion, heat, some emotions,
and also as a reaction to a toxic or poisonous condi-
tion of the body, as in the night sweats of the con-
sumptive and in rheumatic fever, for instance.

ANATOMY AND PHYSIOLOGY 13

The skin retains its vitality for some time after
removal from the body. In this way skin may be
grafted from one part of the body to the other or
from one person to another, as in plastic operations.
Small portions of skin can be kept alive for some
time by laboratory methods. As to the epidermis
that has been employed for grafting too, and is the
usual way of carrying out that procedure to cover
denuded and ulcerated surfaces. Thin layers are
shaved off with a sharp flat razor and transferred
with certain precautions to the surface that requires
to be treated. The soft living epidermic cells on the
under surface of the pieces thus removed catch on
and become adherent to the denuded parts, and in
this way quite large areas can be dealt with. Another
method was to snip off quite small bits of epidermis
and dot them over the denuded surface here and
there, new epithelium growing from them and join-
ing up to cover in the ulcerated parts.

This vitality of the skin and the epidermis leads
me to allude in passing to the electric phenomena in
the shape of electric currents which were first observed
and studied in the skin of frogs and later in fishes.
The electric eel and torpedo-fish are well known ;
and, not so many years ago a man-torpedo was on
show who gave shocks to people, but that is another
story, the fish story being in this case the true one
and the other artistic. The skin offers resistance
to the passage of electric currents from without, a
resistance which varies with the strength of the
currents employed and also with the condition of the

I4 THE HEALTH OF THE SKIN

skin. The skin, when dry, is more resistant than
when it is wet, that is why in some forms of treat-
ment, as in electrolysis for instance, the electrodes
have to be moistened. Electric baths have little
effect on the skin as a form of treatment, whatever
may be the case in general conditions which do not
come within the scope of this book. But it may be
as well to say that catching hold of a source of
electric power whilst in a bath may lead to fatal
results. Accidents have occurred in this way and
are occasionally reported in the papers. As to
electric belts, they have not the vogue they had a
few years ago. To expect any therapeutic action
from such devices is a delusion. Admitting for a
moment that slight currents are generated in the
metallic discs of such belts, there is the resistance
of the skin to be considered, and in addition, the
fact that contrary neutralizing currents are set up
in the discs. In these days of electric installations
of various kinds, exact notions as to electric forces
are becoming more and more prevalent, and that
may account for the electric belt business being less
flourishing than it was.

In the old days, the torpedo-fish was used in treat-
ment by the Greek and Roman physicians. Aris-
totle pointed out that this fish numbs the fishes it
preys upon for food, and Scribonius Largus, a Roman
doctor, wrote that during the acute gouty attack a
live black torpedo-fish applied to the foot, on the
beach, until the foot and the leg up to the knee were
numb, relieved the pain. As to the man-torpedo,

ANATOMY AND PHYSIOLOGY 15

I came across the following in a recent criticism of a
novel : ' Besides this he could at will suddenly
liberate electricity from his hair, skin and nerves,
like an electric eel, which paralyzed for a moment
his opponent's grip/ This is somewhat exaggerated,
but one must make allowance for writers of fiction.
It is fortunate that this sort of thing does not occur
in real life. Patients (women) occasionally state
that their hair is electric and that sparks come from
it when combing it. The hairs of a cat briskly
rubbed become to some extent electric.

By means of special apparatus various substances
can be driven into the skin electrically, that is to a
certain extent, by ionization as it is called. This
when employed legitimately is a useful form of
treatment in some affections of the skin, but know-
ledge of the skin and the morbid changes which take
place in it is requisite. Unfortunately electric treat-
ment gets into the hands of ignorant people, much
to the detriment of such methods. The word elec-
tricity is one to conjure with and wonders are pro-
mised and expected from its use.

From what has been said in this rapid survey of
the architecture and functions of the skin, it will be
readily seen that the integumental covering of the
body is a complicated mechanism and not the simple
covering it is generally supposed to be.

CHAPTER III

PHYSIOLOGICAL AND MORBID VARIATIONS

THIS complexity explains many skin conditions,
for any one or more of the separate structures we
have described may be either deficient or over active.
Thus there may be very little hair or it may be
poor in quality. On the other hand its growth may
be excessive and run in families, as in the case of the
hairy Skye-terrier faced Russians who were a sensa-
tion some years ago in London. Or again one meets
with bearded ladies among the freaks of Barnum
shows. Some individuals may be more or less hair-
less like the hairless dogs. Hair varies too from
race to race in appearance and quality, and ranges
from that of the lank-haired North American Indian
to that of the curly headed negro. Colour again varies
greatly through all the shades of a chromatic scale,
to say nothing of the artificial shades. Dyeing of
the hair is a very ancient procedure. The much
admired Venetian red of the Italian artists was
artificial. In albinos, the hair is white from absence
of pigment and this goes with pink eyes as in a well-
known breed of rabbits. Rarely the absence of
hair may be congenital, that is the patient may be
born without hair, and remain hairless. This may

16

PHYSIOLOGICAL AND MORBID CHANGES 17

not only affect the scalp, but also other parts as well,
which are normally hairy.

The skin may be deficient in sweat and in lubri-
cating material and consequently be very dry and
scaly. This dryness may be so marked as to give
the skin the appearance of fish scales or a degree of
crocodile skin aspect. The opposite of this condi-
tion is a great excess of the fatty secretion when the
skin appears coarse, thick and oily. In negroes, this
is often very obvious. Sweating, too, may be greatly
in excess, especially about the palms, soles, armpits
and so forth. In some cases localized areas of the
body surface may exhibit excessive sweating and the
other parts remain dry. The sweat in some instances
may be very offensive and assume a dirty hue. The
odours of the skin are various. According to Plutarch,
Alexander the Great smelt of violets. On the other
hand, Henry of Navarre and Louis the Fourteenth
of France were an offence to others. In some con-
ditions, the skin may smell like iris, or be unpleasant
as in the case of the greasy and unwashed. Red-
haired and some dark individuals are liable to smell
strongly. There is also the odour of sanctity. We
shall deal with some of these conditions more fully
later on.

The colour of the skin generally needs merely to
be mentioned in passing from the point of view of
the variations which present themselves in the races
of the globe. Among the Japanese, who are of
mixed descent, babies exhibit pigmented patches
about the buttocks, and this is looked upon as

i8 THE HEALTH OF THE SKIN

a racial characteristic. But it has been observed
among other Asiatic races and in those of negroid
descent. In the two sexes of the same race the
differences are well known. As to the individual,
disease leads to colour changes in the skin, as in
jaundice (which merely means yellow) for instance,
* yellow as a guinea ' as the popular saying goes.
The ancients called it icterus, the name of the golden
oriole, and they thought that if a man suffering from
jaundice looked steadily for some time at that bird,
the bird died and the man lost his jaundice. Or
changes in the distribution of the pigment may occur
leading to the formation of white areas, which do not
take on sunburn. When these white patches appear
in dark and black skinned races, the contrast is very
great and the individual becomes pie-bald. This is
often referred to as the white leprosy, but as a matter
of fact it has nothing to do with true leprosy. In these
white-patch cases, the hair of the scalp may also be
affected and permanently white tufts show in the
midst of the otherwise dark hair. The famous white
elephant of circus-shows is really an instance of this
condition. But a white tuft of hair maybe due to dye-
ing the other parts black or of a dark shade, the white
lock being the natural colour of the hair as a whole.
Or the skin may be so lax and thin as in the so-
called ' elastic skin ' men, though this pulling out of
the skin in large folds is really due to a want of the
elastic constituents.

' My skin hangs about me like an old lady's gown.'

Henry IV.

PHYSIOLOGICAL AND MORBID CHANGES 19

Further the blood-vessels, lymphatic channels
and nerves of the skin may all be interfered with as
a result of disease, leading to blueness of the ex-
tremities, paroxysmal dead waxy fingers, altera-
tions in sensation, and so forth.

Owing to the fact that the skin is so liberally
supplied with special nerve terminals a variety of
disordered sensations may ensue. The commonest
is itching of the skin, which accompanies many
cutaneous diseases. Sometimes this symptom is the
dominant one and very intense, leading to great
mental distress, which may verge on the suicidal,
sleeplessness and interference with the body func-
tions generally. Fortunately, a recent method of
treatment, which relieves the central nervous system,
usually acts most beneficially and in a rapid manner,
proving experimentally, how intimately the skin and
nerves are related to one another. On the other
hand, continued mental stress and want of sleep
may lead to a form of eruption on the skin, which
when widespread is in itself so irritating as to lead
to further depression of the sufferer, in a word to
what is called a vicious circle. It is well known
that shell-fish, strawberries and so forth may give
rise to irritating rashes of the so-called nettle-rash
type. Drugs and poisonous foods, such as tinned
meats and so forth that have undergone putrefac-
tive changes may also occasion outbreaks of this
kind. When a tin is ' blown/ as it is called, the
contents should be destroyed, for it shows that the
stuff has undergone decomposition and given off

20 THE HEALTH OF THE SKIN

gases. Opium taken over long periods leads in some
cases to great irritation of the skin. De Quincey,
the author of that masterpiece of prose ' The English
Opium Eater/ relating his experience of the drug,
says : ' there arose a new symptom, viz. an irrita-
tion of the surface of the skin, which soon became
insupportable and tended to distraction/ This
irritation may also be observed in those who indulge
in morphia.

Wounds of the skin should be attended to in a
methodical manner, in order to prevent the entrance
of disease germs. They should not be sucked by
another person, for this has more than once led to in-
fection of an unpleasant nature owing to the diseased
condition of the mouth of the good Samaritan.

As to parasites, the presence of a single flea about
the body in some individuals is sufficient to upset
them considerably. A common disease is the itch
itself. This is due to a minute mite or acarus, which
is not a true insect, for it has eight legs in the adult
or full-grown condition and is related to the spider
family. The amount of scratching this small pest
may cause may be very great and affect a consider-
able area of the skin. Scratching may occur during
sleep as a result of what is called reflex action, the
scratching waking the patient up. Napoleon the
Great once suffered from itch and for a considerable
time, as the cause was not then known to the medical
profession. The Emperor was very angry with his
medical attendants, because they could not cure
him at once. Later, another Corsican, Renucci, a

PHYSIOLOGICAL AND MORBID CHANGES 21

medical man, brought the little mite, which is the
cause of so much discomfort, to the notice of the
profession. It is an interesting little female crea-
ture, which burrows under the superficial layers of
the skin and there deposits its eggs. The young
have six legs only, but later in life they develop eight
legs by a process of moulting or metamorphosis.
The male acarus was discovered much later by a
French observer. The male roams about, leaving
the lady in her bower. He is very difficult to find,
and in my opinion this is probably due to the fact
that the female makes a meal of him, after impregna-
tion. This form of cannibalism is well known to
occur among some spiders and insects. The itch is
communicated either directly by one person to
another or by means of contaminated bedding or
clothing. In a book on Architecture and Domestic
Engineering, Vitruvius, who lived in the time of
Caesar and Augustus, curiously enough refers to the
itch and mentions pitch for its cure. Job, who
complained so much of his ' boils and blaynes/ very
possibly suffered from the itch. But pot-sherds are
not to be recommended as a mode of treatment.

There are many other parasites that live on man
and make a host of him for their food-supply. A
common one in some districts at certain times of
the year is the harvest bug, which attacks animals
as well as human beings. In its early life it is car-
nivorous and lives on blood, but in the adult re-
productive period of its existence it is a strict vege-
tarian. This mite attacks the legs chiefly in man,

22 THE HEALTH OF THE SKIN

and the rash it leads to may be very severe and
troublesome. Dogs and rabbits may be affected
in this way. And as to the former, the parasite
may be communicated from them to man. The
harvest-bug has even been brought to an invalid
in one case in a bunch of flowers picked in a corn-
field.

The body-louse occurs chiefly in the wretched and
the flotsam and jetsam of our so-called civilization,
those unfortunates who come down in the world
and fluctuate from common lodging-house to common
lodging-house. In many cases, such individuals are
much to be pitied. It was a miserable sight in my
student days to see these poor creatures snatching
a few hours of disturbed sleep on the seats of the
Thames Embankment in the early hours of the
morning. What dreamed they ? For there is no
doubt that dreams may be started by irritation
about the skin, just as the noise of a barking dog
at night may act in the same way where it does not
wake one up completely. In chronic cases of this
condition of lousiness of the body, the skin becomes
deeply pigmented and to this the name of vaga-
bond's disease has been given. The louse is a
wonderful little insect which lives on the blood of
its host. It has a long proboscis, the extremity of
which is provided with four minute hair-like struc-
tures. By their approximation, they form a stabbing
point which perforates a superficial blood-vessel of
the skin and the blood is then sucked or drawn up,
probably by capillarity, into the insect's stomach.

PHYSIOLOGICAL AND MORBID CHANGES 23

If a louse is examined under the microscope after
its aldermanic feast, the coils of intestine will be
seen to be in active motion. This I thought some
years ago I had discovered, but I found that Leeuwen-
hoek, a Dutch naturalist of the seventeenth century,
had already noted the point. He considered the
blood was thus kept in active motion to prevent its
clotting, which would kill the animal. Lice breathe
through the skin by a system of minute tubes or
trachea. If these are occluded by any sort of sticky
fluid or ointment, the insect dies. A common mode
of treatment, i.e. the use of ordinary paraffin lamp
oil is rational, but this should never be employed
near a naked light or the patient's hair may catch
fire and lead to a fatal issue, for burns about the
head are very serious indeed.

It is a popular belief that the skin of some indi-
viduals breeds lice. This is quite an error, but I
have no doubt this superstition will linger on for
many years in spite of the schoolmaster being so
much abroad in our age of so-called education. Lice
are not spontaneously generated as such a notion
would imply, though it is one that has received
support from a statement by Aristotle, to whose
authority everybody bowed down until Leeuwen-
hoek and Swammerdam in the seventeenth century
showed the contrary. Aristotle said that ' nits '
were sterile. As a matter of fact ' nits ' are the
eggs of lice, which in the hairs of the head are
attached to them by the female insect. These ' nits '
are firmly fixed to the hair by means of a cement

24 THE HEALTH OF THE SKIN

substance secreted by the insect. In dealing with
children who have ' nits ' it is therefore of the
greatest importance to detach them by firmly wiping
the hairs with an antiseptic solution, or better still
cutting the hair off short and burning it. I have
found it very difficult to make parents understand
this origin of the insect, the idea that the latter are
bred by the skin being so firmly rooted in the minds
of many of them. Though in error, they are in
good company, for Sulla the Dictator was supposed
to have died as a result of these insects practically
eating him up, in such numbers did he breed them
in his skin, all of which may be read at large in
Plutarch's ' Lives/ Recently it has been shown that
lice were the conveyers of Typhus (not Typhoid)
fever, which is seldom observed in England now.
It occurs among tramps. This disease was no
doubt the old jail-fever, of which an early English
writer, Andrew Boorde, of the fifteenth to sixteenth
century quaintly but truly remarked, that the way
to prevent it was to keep out of jail.

It is well known now, thanks to scientific research,
that various diseases are inoculated through the
skin by the bites of insects, as malaria and yellow
fever by certain mosquitoes, sleeping-sickness by a fly
prevalent in certain parts of Africa, and plague by
fleas. It is extremely important therefore, in the
tropics especially, to protect the skin carefully by
mosquito netting and suitable clothing, together
with other precautions.

We have already alluded to nettle-rash, but there

PHYSIOLOGICAL AND MORBID CHANGES 25

is a condition of the skin in which constantly recur-
ring attacks of wheals occur over long periods. In
such individuals, stroking or touching the skin leads
to wheal-like reactions. In the middle ages, sufferers
of this kind were very unfortunately situated, for
when they were accused of demoniac possession
and sorcery, the fact that the imprint of the hand
and fingers could be produced in relief by a forcible
application of the outspread hand to the suspected
person's back was deemed to be evidence of their
guilt.

In some children, the skin may be easily upset in
the way of nettle-rash reactions as a result of un-
suitable foods and disturbances of the alimentary
tract. In them, this skin trouble may be very
obstinate and require suitable persevering treat-
ment. In children again when flea-bites are numerous
this may start a certain amount of nettle-rash. At
any rate, such children are very miserable as a result
of this. In North Africa among the various natives
a small kind of flea is a veritable plague preventing
all sleep. A French writer has recently pointed out
that if this fleasomeness could be stamped out, the
difficulties of the Algerian question would be solved.

Whilst on the subject of children, it is wise not
to allow them to be kissed in a promiscuous way,
by strangers especially, as serious infections have
thus been caused through abrasions about the lips.

In some diseases, the sensations of the skin surface
are altered as to heat, cold, pain and pressure owing
to nerve disturbances. Or other changes may occur

26 THE HEALTH OF THE SKIN

in the texture of the skin, such as thinning or thicken-
ing over certain areas. In certain stages of leprosy,
the surface of the skin may become soft and sapona-
ceous to the feel, and this was taken advantage of
in the old days in suspected lepers, by pouring water
over the affected parts. In his ' Natural History of
Selborne/ Gilbert White refers to a boy in the village,
who had a kind of leprosy of a singular kind, since it
affected only the palms and soles. It was a scaly
eruption, which broke out twice a year. This was
not leprosy at all, but a totally different malady.
White adds that ' the good women, who love to
account for every defect in children by the doctrine
of longing, said that the boy's mother felt a great
propensity for oysters which she was unable to
gratify, and that the black rough scurf on his hands
and feet were the shells of that fish. We knew his
parents neither of which were lepers ; his father in
particular lived to be far advanced in years/ Here
we have the maternal longings cropping up again.

Normally the skin develops simultaneously with
the other structures : bones, muscles and so forth,
but arrested development may occur as far as the
integument is concerned and malformations be the
result. Thus the branchial clefts may not close up
properly and leave small openings in the neck.
These branchial clefts are the gill-slits, which can
be well seen in sharks and the dog-fish for instance,
and are present in the early stages of development
of the human embryo. In the higher group of
fishes, the gill-slits are more highly differentiated

PHYSIOLOGICAL AND MORBID CHANGES 27

into gills as in herrings, mackerel and so forth. Or
again, there may be gaps in the skin of the body,
and it may be absent as also the corresponding
underlying ribs. For when there are skin deficiencies
other structures generally suffer too in a similar way.
The skin may be absent owing to non-development
over the lower part of the abdomen and the bladder
be exposed in consequence. A web between the
lingers may persist and two fingers, usually, some-
times be adherent to each other all the way up.
Malformations of the skin occur too about the nose,
eyelids, ears and mouth. In the last named situa-
tion hare-lip is not an uncommon deformity, often
associated with incomplete development of the
palate, in the condition known as cleft palate.

What is popularly supposed to be a deficiency in
the number of skins is quite another malady, in
which the patient, usually a male, bleeds considerably
after wounds, extraction of teeth and so forth. They
are called ' bleeders/ but this has nothing to do with
their being short of a skin.

Viewing the skin as a whole, it is essentially an
organ of protection, but in the case of man in the
struggle for existence he has had to have recourse
to the skins of other animals, to leather, to armour,
to shield himself from his enemies.

Man is born naked and helpless, hence the diffi-
culties in rearing, which must have been very great
when he dwelt in caves and was surrounded by
powerful foes, to say"* nothing of climatic changes.
Fortunately man discovered fire, the only animal

28 THE HEALTH OF THE SKIN

who ever has, and this gave him an immediate and
tremendous advantage. No wonder the gods of
old punished Prometheus for stealing fire from the
chariot of the sun, by chaining him to a rock, what
time a vulture fed on his liver, which was never
diminished in size though continually devoured.
The gods knew that fire would be the emancipator
of man. By means of fire, man was able to obtain
warm baths and make soap, and thus keep his skin
clean.

The fatty layer under the skin is important, and
healthy babies have this layer well developed. In
bears this adipose mass may be very considerable,
and man made use of it in the shape of bear's grease
for anointing the hair in early Victorian days. In
some individuals the fat forms tumours under the
skin. On points of pressure pads called bursae may
develop as a protection to the underlying parts, as
the pad on the top of the head, for instance, in some
of the men who unload heavy cases of oranges from
vessels near London Bridge by carrying them on the
head and the upper part of the back, and this not-
withstanding the porter's knot.

Physiologically the skin regulates the body tem-
perature. In this the sweat function plays an
important part, but the nervous system also takes
part in keeping up the equilibrium. In fevers these
mechanisms are thrown out of gear and the tempera-
ture of the body goes up as it is said, leading to great
disccfmfort, especially in severe and continued fevers.
In feverish conditions, the sweat function is usually

PHYSIOLOGICAL AND MORBID CHANGES 29

in abeyance and the skin feels hot and dry. It is
then that tepid sponging of the cutaneous surface
is so grateful. After a certain time, a critical sweat
may occur and the temperature come down.

In those who are exposed to the heat and glare
of furnaces as in foundries and in the stoke-hole of
ships, the sweating of the skin enables these workers
to carry on their arduous labours. The loss of
fluids by the skin have then to be made good by
draughts of water to keep the balance even. All of
which shows how important are the functions of
the skin, a point on which it is necessary to insist
again and again, for the general run of people are
most ignorant about the matter. They talk a great
deal about their livers — indeed the liver is a constant
subject of conversation among us in England — but
little thought is given to the cutaneous covering as
an organ of multifarious activities.

The thickening of the skin about the hands and
soles is well known, but skin changes of this kind
occurring in certain parts of the body may give a
clue to occupations and trades. These callosities
are just alluded to in passing.

As to the colour of the skin, we have already
touched lightly on this. In white, and especially
fair individuals, and more so in children and infants,
the rosiness of the skin is due to the vessels of the
true skin or cutis or corium showing through. In
some races, the yellow, brown and black, the pig-
ment cells intervene and give rise to the variations
in aspect. The changes of colour which take place

30 THE HEALTH OF THE SKIN

in the skin of the chameleon are well known. These
are due to special large mobile pigment-cells set in
motion by some stimulus, apparently one acting on
the retina or pigmented part of the eye. In con-
nexion with this, patterns have been reproduced
experimentally on the skin of flat fish through the
eye, for when such outlined patterns were exhibited
to blind fish the patterns on their skin did not occur.
This has led me to suggest that the excessive freckling
of the skin observed in some people when exposed
to sunlight, especially during the summer holidays
at the sea-side with its well-known glare, may be
due to such a stimulation of the retina, and that
wearing coloured (deep red) goggles might act in the
way of prevention. But I admit this would be con-
sidered worse than the freckles by the majority, of
the women especially. Freckles not only occur on
the face in this way, but may be observed on the
protected and covered parts of the body.

Cutting off the chemical or actinic rays of the sun
has been put forward as a means of avoiding the
bad pitting of small-pox pustules by filtering the
rays through red glass. In some parts of southern
Europe, and in Japan, red hangings about small-pox
patients are still employed. Our own John of
Gaddesden, a physician of the thirteenth to four-
teenth century, and who is mentioned in Chaucer's
' Canterbury Tales/ maintained that he had cured
the king's son by employing red hangings and wrapp-
ings about the bed when the prince was suffering
from the small-pox.

PHYSIOLOGICAL AND MORBID CHANGES 31

There is no doubt that prolonged exposure to the
sun's rays, as in tropical and subtropical countries,
does in time in some individuals lead to changes in
the skin of the exposed parts, that is of the face and
the backs of the hands. Such changes may go on
slowly for a considerable time without leading to
any serious trouble, but eventually changes occur
which may become malignant and necessitate radical
treatment, for ointments and so forth are no use
then. It is advisable rather to consider prevention
and individuals would be wise to protect the hands
and face in the early stages. This is a counsel of
perfection, for sea-farers are prone to these changes
which have indeed been labelled ' sailor's skin.'
Though the conditions of life at sea in this age of
steamers are not what they used to be, mariners
continue to be greatly exposed to sun, wind and
weather. In a general way, a certain amount of
sunlight is good for the skin, for its nutrition is stimu-
lated thereby. Those who work underground are at
a disadvantage in this respect. Children deprived of
sunlight are also apt to suffer in various ways, and
this may be observed in youngsters living in Artisans'
Dwellings or Peabody Buildings, from their originator
in England. In them the children living on the
upper floors, in congested districts where there is no
attached playground, are kept indoors a great deal.
But too frequently, such buildings degenerate into
vertical slums, which are worse than the horizontal
ones in some respects, for at least the latter have
some curtilage.

32 THE HEALTH OF THE SKIN

In this place it is germane to the subject to
allude to the changes which occur in the skin of the
hands of X-ray workers, for in certain ways ' sailors
skin ' is an allied condition. In the early days of
the X-rays, those who used them constantly in a
routine manner did not protect their hands as they
do now. Unfortunately a number of these operators
developed skin troubles, which ended in serious
complications and amputations, and in some cases
death, as is well known to those who read the papers.
Though the X-rays pass through the skin, some of
their constituents may affect the skin injuriously
and produce inflammatory reaction, scars, pigmen-
tation and so forth. But now that more is known
about these rays, various precautions are taken in
the technique of their application for purposes of
treatment, complications are reduced to a minimum
and but seldom occur, especially if one considers
their very general use.

Again the skin may exhibit birth-marks, port-
wine stains, hairy moles, varying in size. Such are
frequently attributed to maternal impressions, but
there are no real grounds for such a belief. How-
ever in this, as in many other popular beliefs, those
who hold them will hold them still. It is no good
arguing about these opinions, and people must
believe what they like. Some hairy moles are very
extensive, and may occupy what has been called in
their case the bathing-drawers' area, extending from
the lower part of body down to the upper part of the
thighs.

PHYSIOLOGICAL AND MORBID CHANGES 33

It would be impossible in this place to go into the
numerous details of the skin changes and diseases
which come under observation. But sufficient has
been said to give an idea of the multiformity of the
appearances which may occur, a fact which makes
the study of skin diseases so difficult.

Just as the skin and its constituents present varia-
tions from individual to individual and from race to
race, so do these structures differ in one and the
same person if we consider them in the various parts
of the body, from head to foot.

CHAPTER IV

TOPOGRAPHICAL VARIATIONS

IF we begin with the head, the skin there or scalp
as it is called is thicker than that of the body
and neck. It is modified in structure and is covered
with hair. In the infant the hair is very fine and
downy. Gradually it becomes thicker and longer.
When baldness in later life supervenes, the scalp
becomes polished and thin, showing frequently the
boundary lines of the bones of the underlying
skull.

' Time himself is bald, and therefore, to the world's
end, will have bald followers ' (Comedy of Errors).

Owing to his baldness, Caesar was nick-named
Calvus, and was allowed to wear the laurel wreath
in the Senate to disguise the fact as much as possible.
The scalp is very much more vascular than the skin
in other parts, and its good blood supply is favour-
able to the healing of clean cut wounds when their
edges are brought together. The superficial layers
of the scalp are fixed to the underlying parts by
fibrous structures, and this is the case too as regards
the skin of the palms and soles.

The distinction of the scalp is the hair. But a
discussion of this must be left to a later opportunity

• 34

TOPOGRAPHICAL VARIATIONS 35

when the hair will be dealt with in a more special
manner.

Though the scalp is the most noticeable hairy
part, it must not be forgotten that the body surface
generally is more or less hairy, only the hair is pre-
sent in the shape of a very downy and ill-developed
growth usually, except in the armpits and other
situations.

Among the North American Indians, an enemy's
scalp was symbolic of victory. The great Sir
Richard Burton shaved his scalp completely when
travelling in the western parts of North America
in order to escape this indignity in case he fell into
their hands.

The skin of the face too has characteristics which
must delay us a moment. The skin of the eyelids
is thin and lax, and inflammatory swellings readily
occur which in eczema and nettle-rash may close up
the eyes. The bagginess of the lower lids is signi-
ficant in certain morbid conditions ; and at the outer
angles, the fleeting of time shows itself in the shape
of crows' feet, in addition to the greying of the hair
at the temples (from tempus, time). The furrows
of the forehead and about the eyes are related to the
emotions, to thinking, frowning, or as a result of
some abnormal states of vision and anger, but also
to laughter and smiling, ' He wreathed his face in
smiles/ said a poet. Be it remembered that the
smile is in origin a modified snarl. Excessive
wrinkling of the face occurs as a result of emaciation
in some diseases, giving the features the appearance

36 THE HEALTH OF THE SKIN

of premature old age. This may also be observed
in new-born infants at times and is due to in-
fectious blood-conditions.

The eyebrows and eyelashes vary in many ways.
The former may be excessive and bristly, or scanty ;
dark or fair, according to race and nationality. In
albinos and red-haired individuals they are usually
scanty. The eyebrows may join up together across
the root of the nose instead of being separated.
This is considered a sign of beauty in women in the
East and among the Moors, and when it does not
exist, art supplies the deficiency. Says Richard
Burton in his translation of ' The Arabian Nights ' :
' A great beauty in Arabia and the reverse in Denmark
and Slav-land, where it is a sign of being a were-
wolf or vampire. In Greece also it denotes a Brukolak
or vampire.' The pencilled eyebrow is the most
beautiful and the rarest. Raphael was very fond
of depicting this in his Madonnas. The skin over
the eyebrows is thick owing to muscular attachments.

The eyelashes may be very long and curved. In
fair individuals of the delicate refined type, the ' non
Angli, sed Angeli ' of old Pope Gregory referring to
young English captives, the length of the eyelashes
taken with other appearances may be indicative of
a tendency to tuberculosis. The red-haired are
prone to this infection. The beautiful tints of
naturally red-hair in women go usually with a milky-
white skin. But such individuals are prone to
freckling as a result of exposure to sun.

When the eyelashes and eyebrows fall out as in

TOPOGRAPHICAL VARIATIONS _ 37

some diseased conditions, their absence gives a
staring look to the face. Here the eyebrows must
be ' pencilled ' artificially.

The skin of the ears is tightly fixed to the under-
lying gristly structure, so that inflammatory swellings
in this region are particularly painful. Hairs occur
in the outer channel and about the ears generally,
very much so in some people.

The sides of the face, the upper lip and chin area
are hairy in the male. This is a secondary sexual
character. The amount varies, but all are not
* bearded like the pard ' and like Esau. Hairiness
is usually taken as a sign of strength, but this is not
strictly so. Samson's strength lay in his hair, which
when sheared by Delilah delivered him into the hands
of the Philistines. This may be a solar myth and
representative of the moon subjugating the flowing
rays of the sun. But hairiness of the face may occur
in women, race and nationality here playing their
part, Southern and Eastern dark individuals usually
being the sufferers. There is a relation between female
superfluous hairs of the face and the genital functions,
when the latter are in abeyance, or at the change of
life. The latter is a critical period in more ways
than one, and from the point of view of looks this
hairy growth on the face becomes a disability, which
sometimes reacts very depressingly on a woman's
natural disposition. This may lead to isolation
and introspection, a vicious circle being started,
ending sometimes in melancholia. In the section
dealing with the cosmetics of the skin this will be

38 THE HEALTH OF THE SKIN

touched upon in more detail. Again in some women,
hairiness of the beard and moustache regions may be
a secondary character of the other sex, hence viragoes
and mannish women. With age, an alternation of
this sexual character is not infrequently observed,
old men becoming hairless and looking like old women,
hence the origin perhaps of the term ' old. woman '
applied to some men, though the gibe is often a libel
on the ' gentler sex/ On the other hand, some old
women, I mean of the female sex, become hairy
about the face and approximate in appearance to
the so-called ' stronger sex/

The skin of the face may be dry and thin, cracking
easily and reacting readily in an inflammatory
manner without much provocation to cold winds
and strong sunlight. As to the latter, in addition
to the light rays, the sun emits chemical ultra violet
(actinic) rays, to which the exposed parts, such as
the face and hands, are in some subjects very sensi-
tive. The rays reflected from snow and ice, as in
the Alps and Polar regions, or from the surface of the
sea, as in the Tropics, especially when a sailing ship
is in the doldrums, affect tender skins. In Alpine
climbers, that the solar rays may lead in this way
to blistering of the skin of the face and neck is well
known ; and at times this blistering may be very
severe. In the expedition to Mount Whitney in the
United States, the members found that the cooler
it grew the more the sun burnt the skin, so much so
that the face and hands of some of the climbers
looked as if they had been seared with hot irons.

TOPOGRAPHICAL VARIATIONS 39

(The peaks were of grey granite and no doubt re-
flected the rays very forcibly.) Browns, reds and
violets are the colours for veils and sunshades as far
as the protection from the sun is concerned, for they
absorb the chemical rays. The counsel of perfec-
tion would be a burnt umber paint. In the coloured
races, the pigment of the skin is a protection. And
in white people, the tanning and darkening of the
skin as a result of exposure is due to the formation
and increase of pigmented protective cells. Those
who suffer from permanent white patches of the
skin find that the white areas do not take on sun-
burn, for in the skin of those parts the pigment-cells
have been driven out. As a consequence of this the
white areas may and do become inflamed and painful
owing to the action of the chemical rays.

On the other hand, the skin of the face may be
coarse and greasy. This is the case in Acne vulgaris,
when in addition one finds what are called ' black-
heads/ This is very disfiguring, not only on account
of the pimples and pustules, but in bad cases matter
may form more deeply in the true skin, and if not
attended to may lead to permanent pock-like scars.
This may also occur on the back and front of the
chest. The disease commences at puberty and is
related to the changes taking place in the sexual
apparatus, that is somewhere about fourteen or so,
more or less. Sometimes parents are told the
affected child will grow out of it, so no attention is
given to the case and the disease is allowed to have
its own way, leading at times to an ugly pitted aspect

40 THE HEALTH OF THE SKIN

of the face, and also of the body when that is affected
too, very detrimental to the individual's looks later
on in life, especially if a girl. A great deal can be
done for this condition in the way of treatment.
But as in the treatment of any disease ' flesh is heir
to/ every case must be dealt with on its own merits,
both from the internal and external points of view.
As to the former, it should be mentioned here that
there are many patent blood-purifying mixtures on
the market and these may aggravate the pimples
and pustules, and lead in some cases to severe skin
eruptions. The same may be said of patent remedies
for fits.

Another form of Acne, viz. Acne rosacea, affects
adults. This is primarily internal in origin and
only secondarily exhibiting itself as pimples and
pustules about the central parts of the face. The
uncharitable often attribute this condition to drink,
but this is not the case in the majority of instances.
There are various forms of indigestion, which give
rise to it, with other factors. But as the Chinese
proverb says : ' A man with a red nose may be an
abstainer, but nobody will believe him/ which shows
how ancient is the unkindness of one brother to
another in our poor humanity.

The face again is a common seat of Lupus vulgaris,
true Lupus, a condition which is extremely rare
among the well-to-do. That is perhaps the reason
why so little is done in the way of suitable homes for
those who suffer from this complaint, and who are
usually not received with open arms in convalescent

TOPOGRAPHICAL VARIATIONS 41

institutions, owing to the great disfigurement and
unpleasant aspect of some of the victims. Though
X-rays, light treatment, and so forth help these
cases, the necessity of good food, fresh air and
hygienic surroundings generally are usually lost
sight of. It is in this disease that it is of the utmost
importance to oppose the. beginning. Were this
always done, the very bad cases would gradually
become non-existent among us. Long periods of
opportunity are frequently wasted by applying all
sorts of ointments and local remedies, which have
no effect whatever on the growth, for it is a growth
in the skin, and not a mere inflammation. I have
seen a young woman, for instance, much disfigured,
half her face being affected, as a result of a Lupus
vulgaris which commenced as quite a small thing
in the centre of one cheek. Had that been destroyed
in the early stages, an insignificant scar would have
resulted. There is another form of skin disease of
the face, though other parts may be affected too,
totally different, but which has unfortunately been
called Lupus erythematosus. It is not the same
disease at all as Lupus vulgaris, which has been
just described. The face in this Lupus erythe-
matosus is affected in a different way. This is
only mentioned in passing, as the name Lupus is
one that naturally frightens people, who do not
know the differences between the two morbid
conditions.

In some parts of the East and North Africa, as
Bagdad and Biskra, there is an obstinate skin affec-

42 THE HEALTH OF THE SKIN

tion of the face usually, which goes by the name of
Bagdad boil, bouton de Biskra, and so forth. In
Biskra, I saw a young Italian boy with several of
these crusted sores about the face, which he did not
trouble about or seem to mind. In Morier's delight-
ful ' Adventures of Hadji Baba of Ispahan/ the hero
says : ' I was attacked by a disorder, from which
few residents, as well as strangers at Bagdad are
exempt, which terminating by a large pimple, as it
dries up, leaves an indelible mark in the skin. To
my great mortification it broke out upon the middle
of my right cheek, immediately on the confines of
the beard and there left its baleful print, destroying
some of the most favourite of my hairs/ It is well
to bear this in mind when travelling in parts where
the disease is prevalent. In the East there is a sacred-
ness about the hair ; they swear by the Prophet's
beard. In that brilliant masterpiece ' The Shaving of
Shagpat ' by Meredith, the single hair of the head,
the ' identical/ is the hero of the story.

The skin of the nose is more and more firmly fixed
to the underlying gristly scaffolding the nearer it
gets to the tip and the sides of the nostrils. The
nose and the surrounding areas are very liable to
black heads and acne in those with greasy skins to
say nothing of those bugbears, shininess and red-
ness, which require the frequent services of the
friendly powder puff in the vanity bag. In some
individuals the end of the nose is sprinkled with
stiff bristly hairs. The nose again, as in Bardolph
and in ' antient ' Pistol may be exuberantly deformed

TOPOGRAPHICAL VARIATIONS 43

through the enlargement of the sebaceous or fatty
glands.

'Thou bearest the lanthorn in the poop, but it is in
the nose of thee.'

This deformity, the bulbous nose, may arise apart
from drink, though indulgence in liquor is often a
factor, but indigestion and exposure to all weathers
as in the case of the old 'bus drivers also play a part.
Gillray has a good caricature of a grog-drinking
Briton of the period (1801) undergoing the Quack
Perkins's metallic tractors' treatment for such a con-
dition, and the patient looks far from happy as the
sparks fly out of his nose. Snuff-taking has gone
out of fashion, but in the hardened that habit did
not improve the appearance of the nose and nostrils.
Pope Innocent xn. issued a ban against all snuff-
takers, but this was later repealed by Benedict, who
took rappee himself.

The skin of the lips is connected with muscular
tissue. The border of the upper lip usually projects
a little beyond that of the lower one, markedly so in
the scrofulous, except in some races with very thick
lower lips. In the Hapsburgs, the lower lip projects
in a very characteristic manner. In France, this
was alluded to as the ' levre autrichienne ' in the
case of Anne of Austria, the consort of Louis xm.
This lip is said to have been brought into the Hapsburg
family by marriage through a Polish princess, a
strong woman who could drive a nail into a wall
with her fist. Julian the Apostate judging from

44 THE HEALTH OF THE SKIN

portraits on coins had a prominent under lip of the
same kind. This deformity is often associated with
a prominent chin. The hairiness of the upper lip
and chin has already been referred to, as also its
unsightliness when it occurs in women, though a
young lady once said that she did not agree with
her mother about it, as ' she rather liked her little
moustache.'

In painful illnesses and depressive states of mind,
the folds running down from the sides of the nose to
the outer angles of the mouth may become very
accentuated and give a down-at-the-mouth look.
Sometimes the crescent-shaped line at the boundary
of the lower lip with the chin is very sharply defined.
At the tip of the chin a well-marked dimple occurs
in the middle line in some individuals. A weak
masculine chin can be concealed by allowing the
hair to grow there, and it is done. Paraphrasing
Ben Jonson's ' Speak that I may know thee/ one
might say ' Shave that I may see thee/

The actual hue of the red parts of the lips is affected
in a variety of ways, as in anaemia, heart-disease,
spirit- drinkers ; good lips and a well developed
chin usually go with good teeth and a good digestion.
The lips are well provided with nerves, blood-vessels
and glands. They are frequently the seat of erup-
tions and swellings. Promiscuous kissing, a silly
habit by the way, should be especially avoided in such
conditions, both actively and passively, as at times
serious accidental infections have resulted. Cracked
lips should always be attended to, as infections may

TOPOGRAPHICAL VARIATIONS 45

find their way into the body by them. When we get
to the neck, we find the skin in front is thin and can
be readily pinched up as compared with the back of
the neck where the skin is tougher. Attached to
the lax skin in the front of the neck there is the
Platysma muscle, which is still fairly developed in
the muscular type of man, but it is no longer the
powerful muscle of some of the other animals. In
the horse and cow for instance, this muscle is put
in action to shake off plaguey flies. In the front
of the neck there is exceptionally a single slight
transverse line of indentation, which the French
call ' le collier de Venus/ In fat babies and
cherubs, the folds about this part are very marked
and require special attention, especially in inflam-
matory conditions of the skin. The Rossetti type
of neck is due to an enlarged underlying thyroid
gland.

The skin of the neck generally is frequently affected
by rashes at the same time as the face. And in
blushing, the neck and the upper part of the bust
show the reddening of the skin especially in some
delicate skinned and fair women. The back of the
neck is a favourite seat of pustules, boils and car-
buncles. Again, the neck in some conditions shows
a darkening with pale areas in certain conditions.
In pregnancy sometimes, especially in brunettes,
the skin of the face may exhibit large brownish
yellow or cafe-au-lait patches, ' le masque de la
grossesse.' In this connexion the striae or scar-like
mottling of the skin about the abdomen may be

46 THE HEALTH OF THE SKIN

alluded to, as they result from the great distension
of these parts, which leads to rupture of the elastic
cutaneous fibres. Such lines are also observed
about the thighs, etc., in people who have been very
fat and become thinner.

The skin about the middle of the chest is more or
less hairy, in men, in some individuals of the dark
type very much so ; it is not necessarily a sign of
strength. Some women occasionally exhibit a certain
amount of hairiness between the breasts, and at
times about the nipples themselves. In this region
pimples and pustules and scaly patches are not
infrequent.

The skin of the breasts themselves is thin and
delicate, the veins showing through. Owing to
this, the maternal breasts expand when filled
with milk. In pregnancy, a darkening of the
skin takes place about the nipples, especially in
dark women. In this area too a growth of hair
may occur.

When the skin is punctured with a blunt but
pointed instrument, it splits in certain lines called
lines of cleavage, reminiscent of the way the body
has been built up in segments.

On the back the skin is thicker than on the front
of the body, and the upper parts are frequently the
seat of acne, which unless dealt with early may
become very disfiguring, owing to the pitted scars
often left behind. At the lower part of the spine
a tuft of hair is sometimes observed, reminiscent of
what is seen in the statues of fauns. This hairy

TOPOGRAPHICAL VARIATIONS 47

growth may indicate an abnormal condition of the
bones beneath.

The eruption called shingles mostly attacks the
skin of the body on one side. There is a popular
notion that if shingles go round the body, that is
form a complete circle, the patient dies. Though I
have seen a number of cases, I have never observed
such a circle ; sufferers have no need to worry about
such an event. The word, a curious one, comes in
my opinion from cingulum, a girdle.

Looking at the body generally, it must be noted
that the skin is thin at the bends of the elbows and
the back of knees, the armpits, the groins, and between
the fingers and toes, as compared with the other
parts. In the palms, the skin is very thickened in
those who work at hard manual labour, hence the
horny-handed, without whom by the way a good
deal of the most unpleasant work would go undone.
In those races that go about bare-footed, the soles
of the feet become thick and horny too. Both palms
and soles are provided with plenty of sweat-glands,
as those who perspire too freely in those areas know
to their inconvenience, and sometimes misery,
though treatment can achieve much in the way of

j relief. As regards the feet, and it may here be
added the armpits too, the sweat may become very
of ensive and lead to hypochondriasis and morbid

] self-consciousness.

The hairy parts of the body also harbour animal

I parasites. This is the reason that among some races

| these parts are shaved. We shall have occasion to

48 THE HEALTH OF THE SKIN

return to this point, when dealing with the subject
later on. The schoolboy who defined a Parasite
as ' a kind of umbrella ' was inaccurate.

After this general survey, we are now able to pass
on more particularly to the Hygiene of the Skin.

CHAPTER V

GENERAL HYGIENE AND BATHS

IN the first place we must consider ordinary clean-
liness and the subject of baths. Though in the
matter of cleanliness of the body generally great
strides have been made in modern times, a great
deal more requires to be done to bring things up to
the perfect standard. It is frequently stated that
cleanliness is next to Godliness. The fact is that
Godliness should be considered impossible without
cleanliness. If the latter is looked after, the former
will probably take care of itself. In pagan times
connected with our own history as a race to go no
further back, it is well known that baths played an
enormous part in the daily life of the ruling classes
of ancient Greece and Rome, for it must be admitted
that the proletarians and the slaves of those times
were perhaps left to get on as to washing as best
they could. But they were not altogether neglected
apparently among the Romans. Wherever the
Romans went, there they established baths and
provided an ample water supply. The beautiful
Roman bath at Bath is an instance, and their wonder-
ful aqueducts are well known, among them the
remains of the one which brought water to old

D

50 THE HEALTH OF THE SKIN

Carthage, from sources many miles away across the
North African plains, and the wonderful Pont du
Gard in France. The baths of Caracalla in Rome,
the ruins of which are one of the sights there, must
have been very magnificent. They occupied a
space of some 700 ft. by about 400.

Among the earlier Greeks, frequent bathing was
considered a mark of effeminacy, but later baths
came much into vogue and were attached to the
gymnasia. In Sparta, it was the fashion to start
the perspiration with hot dry air and follow this up
with a cold bath. In ancient Rome, the custom
was to have a bath every week in a place called the
wash-house near the kitchen. At a later period,
public baths became very general and were opened
from two in the afternoon to sunset. Very small
charges were made ; less than a farthing for men
and a little more for women. Children were admitted
free. In the time of the emperors, the baths of
Rome became very luxurious. We have alluded to
those of Caracalla, but we may mention here the
baths of the wonderful Villa of Hadrian near Tivoli.
No provincial town was without its public bath
and many villages also had theirs. The remains
of a private Roman bath at Caerwent in Monmouth-
shire give one an idea of the bath-room of a Roman
gentleman. In Pompeii again the remains of the
public bath are of great interest. The large baths
were divided into three parts, first, the tepidarium
heated with warm air to encourage perspiration
after undressing ; then the bather took a hot bath

GENERAL HYGIENE AND BATHS 51

in the caldarium, either in a tub (solium) or in a
larger affair like a small plunge bath or piscina ;
finally a cold bath was taken in the frigidarium.
The bather was then scraped with a strigil (strigilis),
as can be seen in the statue of an athlete at the
South Kensington Museum, rubbed down and the
body anointed with oil. A strigil for scraping the
sweaty coat of horses after exertion is a well-known
instrument. In their conquering campaigns, the
baths of the Romans must have played a great part
in civilization ; and where they remained the longest
as masters and protectors, there their influence is
still perceptible. Our City of Bath was Aqua solis or
baths of the Sun, and the towns named Aix derived
their appellation from Aquce. A quarter of Paris is
still termed les Ternes from the old Thermae, for it
must be remembered Paris was the seat of govern-
ment in Gaul during Julian the Apostate's sojourn
in France. Just off the Strand in our own London,
an old Roman bath can still be seen.

With the coming of Christianity, there is no doubt,
among the early and primitive Christians at any rate,
that baths lost ground, for the body was not con-
sidered of any account, whereas the ancient Greeks
worshipped the body for itself, for its form and beauty.
In mediaeval times, however, baths in cities were
much frequented, but they often degenerated into
the stews (in French ituves) of old London on the
Surrey side, as described by the chronicler, John
Stowe. The appearance of a severe infectious
epidemic disease after the siege of Naples at the

52 THE HEALTH OF THE SKIN

end of the fifteenth century led to their desertion and
neglect. Some of these baths were for mixed bath-
ing, so that is nothing new. Poggio, a Florentine
of the quatrocento, has described the mixed bathing
at Baden, in Switzerland, in an amusing little book.
In the cities of Sweden and Russia, baths are much
frequented, in the latter the steam or Russian bath
being indulged in chiefly. In passing we must also
allude to the Moorish and Turkish bath, and the
ceremonial ablutions of Mahomedans, that is, where
water is obtainable. In the desert, sand has to take
its place, or a stone is used symbolically. Again
there is the religious bathing of the Hindus in the
sacred Ganges. Among the Japanese, bathing is a
very prevalent and daily custom, very hot water
being used, such as we could not stand. They have
regular family tubbing parties. Though the writer's
medical experience of the Japanese is limited, he is
bound to say there is a pleasant odoriferous scent
about their skin, which has led some writers to say
that a popular Japanese crowd was not at all un-
pleasant. On the other hand, the Japanese do not
return the compliment, for they complain of the
unpleasant odour of the Western barbarians.

In recent times with us, houses with baths are
becoming more and more common, but it was not so
long ago that quite good houses had no bath-room.
In our Australian Colonies houses without baths in
cities would not now be tolerated ; and in the United
States, baths are general.

As a result of perspiration and variation in the

GENERAL HYGIENE AND BATHS 53

secretions in the way of fatty materials, the odours
of the skin are manifold. Individuals differ from
one another in this respect, as do also races. The
sense of smell in some primitive people is very acute,
as in dogs, and they are able to distinguish one
person from another by the nose. Whether the
Maori mode of salutation by rubbing noses arises
from this I do not know. This olfactory power is in
abeyance and degenerated among many in our
modern town life, or they could not stand being
crowded together in unventilated railway carriages
and in trams and 'buses as they do, to say nothing
of the awful atmospheric conditions which some-
times obtain in our theatres and concert rooms.
These odours emanating from the human skin and
clothing, combined with the stillness of the atmo-
sphere, makes it next to impossible after an hour or
so to enjoy either plays or music. The body-smells
in a crowded railway carriage are not pleasant,
especially when the windows are hermetically closed,
a circumstance which not only obtains on the Con-
tinent, but which can be observed any morning in
first-class compartments full of men going up to the
city in our suburban trains. Juvenal the satirist
long ago referred to the rancid cutaneous odour of
certain women of the suburb of Rome called Suburra,
though the smell is more like that of a stale bread-
poultice. Others again object very much to primi-
tive negroes on this account. In our modern com-
munities, however, washing and baths have levelled
people up a good deal, though much more requires

54 THE HEALTH OF THE SKIN

to be done. Some individuals, women especially, are
so sensitive on this point, that it becomes an obses-
sion. Marcus Aurelius, the philosopher emperor,
was very sensitive about cutaneous odours. There
is the case on record of a woman who could tell
whether her sheets had been touched by anyone
beside herself, so keen was her sense of smell. Haller,
the great physiologist, could not bear the smell
exhaled by old people's skin. It is still believed
by some that acid changes in the skin at the time
of the period can turn milk. I knew a medical man
of the old school, who was quite sure this was a fact
and was very fidgety about it in consequence. When
the fatty secretion of the skin is excessive, the smell
may become marked and one writer compared it
with that observed in the neighbourhood of candle
factories. The skin of infants at the breast gives
forth a sour odour. As to those who are bottle fed,
the aroma is more reminiscent of rancid butter.
After weaning, the odour of the skin improves. The
' goaty ' smell of some men is a frequent source of
complaint. In the aged, the smell of the skin has
been likened to that of decayed leaves. The Eski-
mos and Greenlanders as a result of their diet of
fish and oil, together with their mode of life, are not
very savoury in this respect. The odour of the
skin may be influenced in affections of the nervous
system. Thus a hypochondriac smelt of violets
and a hysterical woman of pine-apples. In another
case, the odour developed was like iris. In the
middle ages, witches were supposed to have a sul-

GENERAL HYGIENE AND BATHS 55

phury smell and this was a sign of Satanic posses-
sion. Saints on the other hand were said to give
forth the odour of the rose, the lily, jasmine and so
forth, a veritable odour of sanctity, all of which can
be read at large in their lives. Saints too could
smell out sinners. A great deal has been written
as to the cutaneous scents developed in the course
of lunacy. As to catalepsy, it has been asserted
that the skin has a cadaveric odour in the trance
condition, and that this has been a factor in suppos-
ing the individual to be really dead, when such was
not the case.

In certain clefts and folds, the accumulation
of fatty secretions gives rise to fermentations
which have a specially unpleasant rancid and
fishy odour.

Another aspect of the matter is the smell com-
municated to the skin by certain condiments and
drugs taken by the mouth and modified by the func-
tional activities and condition of the individual
integument, such as garlic, spirituous liquors,
valerian, phosphorus, sulphur, cod-liver oil and so
forth. In acute alcoholism, observers have noted
an ethereal odour of the skin which they consider
helps to differentiate the comatose condition of the
dead-drunk from that due to apoplexy. It is often
possible to diagnose the trade and occupation of
individuals by the nose alone. The smell of the
stable is well known and it hangs about the person
in a very obstinate manner. I have also specially
noticed the smell of saw-dust in carpenters, of fried-

56 THE HEALTH OF THE SKIN

fish in fried-fish-shopkeepers, etc., without asking
any questions as to occupation. In a disease of the
scalp due to a fungus, i.e. favus, there is a more or
less mousy smell in some cases. The cock-chafery
odour of tramps has been described by Continental
writers. Vidocq, the famous detective, in his ' Memoirs '
says that in a crowd, he could spot a galley-convict
out of a thousand people by the nose alone. It
would take us too far to enter into further details
as to the smell of the sweat in a number of diseases,
but many are familiar with the sour odour observed
in acute rheumatism, in which sweating is a pro-
minent symptom.

In order to cover unpleasant skin emanations, all
kinds of strong scents have been used for ages past.
Sometimes the combination of the added scent and
the odour of the skin make matters worse con-
founded. It is not difficult to distinguish the over-
scented from those who use scent in a legitimate and
aesthetic way. Treatment in many cases can do a
great deal to remedy defects of this kind, though
sufferers are naturally shy of seeking advice. More-
over, some of these unfortunate individuals are not
themselves cognisant of their unpleasantness to
others. Obviously in such cases, extra cleanliness
is indicated, but this is not always sufficient. This
fact is a source of mental suffering and morbid self-
consciousness in individuals afflicted in this way.
As to the fetid odour of the feet in some people, a
special microbe has been described as occurring in
the sweat of these parts. Unfortunately a disability

GENERAL HYGIENE AND BATHS 57

of this kind is often allowed to go on unchecked,
instead of being dealt with.

Although we have made great strides, yet when
we consider the absence of baths in factories and at
the pit-head, we have much leeway to make up.
Especially where the work is dirty or in any way
offensive, baths should be provided as a sine qua non.
The counsel of perfection would be for factory-
workers, male and female, in such industries to don
a working dress on arrival and when the work was
over have a bath and put on their clean clothes again,
leaving their soiled working ones behind. But there
should be no compulsion about it, or it would become
odious. Persuasion and example would suffice.
What is done willingly is done with pleasure. If a
man preferred to do his own tubbing at home in his
own tub he should not be interfered with. Just con-
sider the offensiveness of dirty-soiled clothes and
smelly sweaty bodies in our over-crowded strap-
hanging tubes, trams, trains and 'buses at the end of
the day. It is really disgusting, but that is what
goes by the name of Progress, with a big P. ' Pro-
gression ' if you will, but not Progress, whatever
that means and whither tending. I know perfectly
well that baths are put to strange uses : to store
the coals, grow mustard and cress and even to keep
ducks in, it has been said. In one instance a nurse,
being called to a house to attend a sick person,
asked the landlady if there was a bath in the house
and was told that there was, ' but thank the Lord
we have never had to use it/ she added. Rome was

58 THE HEALTH OF THE SKIN

not built in a day, and time will work wonders.
Marat of revolutionary fame certainly believed in
baths, for did not Charlotte Corday find him tubbing
when she called on urgent business. It must be
noted that Marat had studied medicine and had lived
in England. Indeed one of his short treatises was
written in English.

Though there are apparently apostles of ' how to
be happy and healthy without washing/ it is on the
whole advisable to keep one's skin clean. Most
native races take to water, except the hairy Ainus
of Japan apparently, for I have read somewhere that
these people were quite surprised at the bathing and
washing propensities of a European traveller among
them. They thought he must be very dirty to in-
dulge in such practices.

Those who are able to take a morning cold tub
have a great advantage. It is both good for the skin
and for the general health, owing to the tonifying
action. But those who have not a good circulation
and reaction, and this is the case with many women,
should take the chill off first, by the addition of warm
water. Cold sponging or a cold douche or plunge
after a warm bath is extremely good for bracing up
the skin, that is in those who can stand it. This was
well known to the Romans as we have shown.

As to warm baths, they should not be taken too
hot, nor should they be frequent and prolonged as
this relaxes the tissues. Soap is essential to remove
the products of the fatty and sweat glands. But it
is not necessary to use strong soaps. Exceptionally,

GENERAL HYGIENE AND BATHS 59

some skins cannot stand soap of any kind. Then a
handful of bicarbonate of soda to a full bath, or bran,
or oatmeal can be used. Medicated soaps are really
not necessary, and their effects on the skin are over-
rated. The folds and clefts of the body and the
armpits should be especially attended to, and this
applies to hairy parts except the scalp. It is not
good to be constantly and daily douching the hair of
the head with water, though it is a common practice.

In those with a tendency to dry skin, mild curd
and Castille soaps are useful. But they must be of
good quality and not overdone. A fatty preparation
may be required in some cases where the skin is ex-
ceedingly dry. In all cases, after carefully drying,
a good toilet powder should be applied to the folds
of the body, and this is to be recommended. Indi-
viduals vary so much as to washing and baths that
no rule can be laid down as to their frequency, so
much depending too on the kind of skin, the occupa-
tion, age and other factors.

Warm baths are beneficial at night as they fre-
quently exert a sedative effect and lead to sleep, a
point of importance, for the skin is, as I have shown,
intimately connected with the nervous system and
other functions of the body. Sleep is beneficial to
the skin ; hence no doubt the old saying as to
' beauty sleep before midnight/ After a fatiguing
day, especially as a result of physical exertion, a
warm bath is much better than a cold one, for the
former soothes the body surface and tired nerves
for the same reason. Insomnia, wakefulness, dis-

6o THE HEALTH OF THE SKIN

turbed nights, make all the difference to the skin, for
in these conditions the skin of the face especially is
not relaxed into that placidity of the features which
one observes in those who are sleeping quietly and
healthily. The passions and emotions, and the
mode of life as to eating and drinking, all reflect
themselves on the surface, and influence the skin in
a variety of ways.

Cleansing the face at night should be the rule in
order to get rid of the perspiration and dust of the
day, especially in our cities, and allow the pores to
take on a healthy state, instead of being clogged
with fermenting materials. As a rule the face in the
delicate skinned, women chiefly, cannot stand much
or any soap, but the parts must not be neglected on
that account. Glycerine and rose water are some-
times useful here. Some skins again derive benefit
from the application of weak alcoholic solutions.
In other individuals again, rubbing in a pure good
simple face cream is beneficial, but as to such appli-
cations being skin-foods, that is all nonsense.
Antiseptic baths and strong lotions are not necessary,
indeed may be harmful in ordinary healthy skins.
It is another matter in diseased states, with which
we are not concerned here. Nor can we go into
details of the various waters of a number of health
resorts, which are sometimes useful as baths when
properly employed. In some places, the hard water
irritates the skin and should not be used in the
sensitive. Whenever possible, rain water is the best.
This is readily obtainable in the country, but in our

GENERAL HYGIENE AND BATHS 61

smoky cities this source of supply is not available, so
we have to fall back on water that has been boiled
and allowed to stand, or distilled water, or water
that has been softened. Rain water can be
passed through muslin to get rid of smuts and
cleared to some extent in that way. Exposing
the face to soft warm rain is not only pleasant,
but beneficial.

Fresh milk may also be used, applied on cotton
wool. Milk baths have been employed by the
fastidious and unoccupied of the gentle sex. The
Empress Poppsea Sabina, wife of Nero, travelled
about with a number of she-asses in her retinue in
order to indulge in baths of this kind. Effervescent
champagne baths have also been used we are told,
but I have never known of an authentic case.
Aberrations of all kinds are found in our humanity
and this has probably been one of them. Gaseous
carbonic acid baths, however, are very refreshing
to the skin. Sulphur baths in the form of Potassa
sulfurata are sometimes ordered for parasitic skin
troubles, but they blacken and spoil utterly metallic
or enamelled baths. Sulphur itself is not soluble
in water.

A good and pleasant thing for the skin is gentle
massage under warm water sprinkled over the bather,
as in the Vichy douche-massage, followed by a cold
plunge and a rest tucked up in blankets on a couch.
Here again the intimate connexion between the
nervous system generally and the skin is well ex-
emplified by the excellent general sedative result

62 THE HEALTH OF THE SKIN

obtained. Sea-water baths are good in those with
a good circulation and healthy skins, but in some
individuals and when the skin is inflamed they are
harmful. In some cases, it is as well to clean off
the sea-water by means of warm fresh water as is
done at French sea-side places.

Exposure to strong wind and sunlight is not good
for the complexion in the case of women as a rule.
They cannot have it both ways, and if a good com-
plexion is desired then they must take care of it.
It depends on the point of view. Some women take
extraordinary care of their skin, especially of the
face, whilst others pay no attention to it. That is
a personal affair and individuals will please them-
selves in this respect.

As to the hands, they need attention, if the in-
dividual desires to have them in good condition.
They should not be washed too frequently, and
be protected by gloves. But in some occupations,
frequent washing is a necessity. Then it is best
not to use strong soaps, unless the hands are
hardened and horny or dirty and soiled, as in
certain trades.

The feet, especially between the toes, require
great attention, though this is a part of the body
which is but too frequently neglected. When this
is the case, offensive odours are apt to develop, as
a result of fermentations. What we have said of
the feet applies to various folds, interstices, and
clefts, which require regular and proper ablution.

With regard to the new-born, they must be care-

GENERAL HYGIENE AND BATHS 63

fully looked after as to the cleanliness of the skin.
The child is born with a fatty varnish (vernix caseosa)
over the body, which gradually peels off leaving the
skin red and tender beneath for a short time. The
conditions outside the body are very different to
those within the womb. Tepid water, and not hot,
should be employed to avoid scalding the infant.
If the natural varnish does not come off readily,
this should be removed with a little cold cream and
rough friction avoided. Later on, strong soaps
should not be used, for the skin of young children is
very different in sensitiveness to applications and
in texture to that of grown-ups. Nowadays one
not infrequently finds that strong alkaline soaps,
such as are used for washing clothes, are being used
inappropriately for them.

Fuller's earth for infants cannot be recommended,
though in general use. Good plain simple toilet
powders are better. It is on record that some
children were made ill from the use of a violet
powder which was found to contain thirty-eight per
cent, of arsenious acid (arsenic). A new-born infant
was dusted with the powder twice on the first day,
and again on the second day. As the skin became
very red the powder was more freely used, but as
the redness got worse starch powder was substituted.
But the infant died on the tenth day from exhaustion
caused by sloughing of the skin. Great care should
be taken as to changing the napkins, for if soiled and
allowed to remain on they irritate the tender skin
of the folds very much and make the child miserable.

64 THE HEALTH OF THE SKIN

It is important to bear in mind that poisoning may
occur in infants and children by applications of
strong carbolic solutions. Carbolic acid prepara-
tions applied to the skin of small degenerate dogs has
led to their death.

CHAPTER VI

CLOTHING

THE new-born, after the skin has peeled oft its
varnish, perspire freely. It is important to
bear this in mind in the matter of clothing. Many
infants are often wrapped up in so many garments,
that the process of undressing is like taking the
layers off an onion or unrolling an Egyptian mummy.
Remember the infant can only show its discomfort
by crying and restlessness ; a state of affairs due it
may be to too many coverings or to their tightness
or to ordinary pins sticking in them, when it is not
due to thirst. Infants often require plain water to
assuage their thirst and keep the skin function going,
but in many instances in answer to their automatic
vocal entreaties they only get a beastly bit of rubber,
at times not overclean, to suck. ' I asked for water
and thou gavest me vulcanite/

The question of clothing too in adults is an im-
portant matter from the point of hygiene, especially
as regards the materials worn next to the skin.
Thick flannel and woollen under garments often
lead to excessive sweating and irritation. It is
wonderful to behold sometimes what dreadfully
thick and hot things are worn in this way, from

66 THE HEALTH OF THE SKIN

neck to ankle, especially woollen materials. Sheep
are woolly creatures, but that does not prevent
them having all sorts of complaints. Cotton and
linen materials are much more grateful to the skin,
and healthier. At first the Romans wore wool
generally. The women among them were the first
to exchange wool for linen and very sensible too.
Later the men adopted linen ; it was a luxury.
Warmth can be obtained by mixing in silk, for silk
is a bad conductor of heat. Flannelette should never
be used, owing to its inflammability. This is, or
should be well known, yet year by year the deaths
of children are recorded as a result of burns. Exten-
sive burns of the skin are frequently fatal owing to
the severe shock to the nervous system for the
reasons we have mentioned when dealing with the
structure and development of the skin and its inti-
mate connexion with the nervous system. The
skin can be trained from childhood by suitable
clothing, with due attention to the seasons and
without overdoing the Spartan business. One
point to bear in mind is that infants should not be
rolled up like mummies, but the active skin given
some freedom and ventilation.

As to clothing and underclothing, men, chiefly in
some classes in this country suffer from too many
thick garments, which must take much of the;
energy out of them, especially in hot weather. There
is a correlation between the amount of clothes and
the mental and social outlook. The upper and
cultivated classes are more lightly and sensibly clad

CLOTHING 67

usually than their brethren not so high up in the
scale or not so fortunate. Linen ' shorts ' and thin
underwear generally are usual among the former.
Light linen and zephyr shirts, with or without a vest
underneath, the latter for preference, and light weight
clothes are coming more and more into vogue for
the dog days. In the hot weather, a Roman toga
and sandals would be appropriate, but what would
happen if men walked about Piccadilly and Bond
Street in this way, I do not know. Why again the
police on duty in our streets should not have more
suitable summer uniforms is another point that
strikes one especially when they have to stand in the
hot sun controlling the fearsome ' traffic ' of our
streets at Oxford Circus and elsewhere.

' The policeman with uplifted hand,
Controlling the orchestral Strand.3

The difficulty, however, is our changeable climate.
Howbeit, men are usually overclad. Women, on
the other hand, are much better off and more sensible
in this respect, taking it all round, though in some
walks of life they are still overloaded with garment
on garment. At the present time, women are
shedding one article of clothing after another in a
way that alarms many good people. But from the
point of view of the functions of the skin it cannot
be said to be at all bad. On the contrary. These
kaleidoscopic and lightning changes, however, are
not commanded by hygienic considerations, but by
tyrant fashion. In one of his books, Nietzsche

68 THE HEALTH OF THE SKIN

remarks, referring to clothes, that, however scanty
a woman's evening toilette might be, she would not
catch cold if she felt she was well dressed. Equa-
nimity of the nervous system no doubt.

The top hat in men is being more and more left on
the shelf, though it still holds its own notwithstand-
ing its cumbersomeness. But there is something in
the tall hat especially when cocked on one side, as
Matthew Arnold remarked of the late Lord Wemyss,
that appeals to those in whom the spirit of dandyism
has not entirely died out. That it leads to baldness
is not supported by evidence. The ordinary boater
straw hat, though in great use, is heavy and usually
not at all comfortable. It cannot compare with the
panama, whether real or imitation, from an all round
point of view. Trilby felt hats should be lighter in
weight and have no linings, which make the head hot.
Men's hats should be ventilated by perforations in
the top of tall hats, and at the sides, front and back
in the case of bowlers.

As to the headgear of women, hygienic growls will
make no difference, and indeed some of the airy
structures which seem to have alighted by accident
as it were, are not at all bad from our point of view,
were it not for the hat-pins. When hat-pins drag
on the hair of the head and the hats are heavy and
clumsy, there is no doubt that it is bad for the scalp
and hair. It must be remembered, that women
sometimes live all day in their hats.

Children are much more sensibly dressed as a rule
than they used to be. They have now plenty of

CLOTHING 69

freedom for movement and also for the ventilation
of the skin.

In the matter of garters, a word is needed. Women
should wear suspenders or garter above the knees.
When gartering is done below the knees, the circula-
tion in the lower limbs, especially in the erect position,
is impeded. This accentuates varicose veins, if it
does not directly lead to them, and this is one of the
causes in the production of chronic cutaneous in-
flammations and ulcers of the legs, which are so
frequently observed. Elastic garters used in the
wrong place are bad enough, but when bits of string
and tapes are employed the chances of congestion
and inflammation of the skin and the subsequent
development of these painful chronic ulcers are much
greater.

With regard to stockings and socks, those of
brilliant hue due to aniline dyes sometimes lead to
inflammatory conditions of the skin. But this is
not at all common.

Boots and shoes should be light, unless heavy foot-
work is engaged in. As a rule the boots that are
worn are much thicker than they need be, as also
are the socks. In some individuals, toed-socks
appear to add to their comfort. The shape of boots
and shoes is a matter of personal taste, though very
tight fitting and pointed foot-gear do in many cases
lead to corns, and deformities of the toe-joints such
as bunions, which are the result of constant pressure.
There are very few people with well shaped feet and
toes. On the other hand, ' hygienic ' shaped boots

70 THE HEALTH OF THE SKIN

are not aesthetic in appearance, and where hygiene
and appearance clash, the former goes to the wall.
This is especially the case in women, and whatever
the discomfort, the majority will follow the dictates
of fashion in the way of shape and heels. As to high
heels, all kinds of morbid conditions have been attri-
buted to them, even insanity. There is no doubt,
however, that uncomfortable boots, pressing on corns
and so forth, do tend to react on the temper. In
these days of machinery, the art of making boots to
measure is dying out, which Carlyle already felt in
his time and fulminated against in his usual way in
his ' Sartor Resartus ' or the tailor re-tailored.
Machine-made boots again are frequently very
clumsily made and chafe and worry the skin of the
feet. Sandals and light rope-soled shoes suit many
people. Quite recently there was a picture of a
Parisian lady wearing toed stockings and sandals.
Sandals are comfortable enough when worn with the
feet bare, but when the latter are covered with socks,
they do not answer, for the grip is lost. In tropical
and sub- tropical countries, it is not wise to go about
bare-footed and bare-legged in a general way.
Various skin troubles may be contracted in this
manner, to say nothing of serious general infections.
The importance of the foot-gear of troops is well
known to commanders and military surgeons, and
special attention is given to the care of the feet in
the army.

Corsets again are of use as a support to the skin
and underlying organs, provided they are properly

CLOTHING 71

made and sensibly worn. But here again, notwith-
standing the warning words of anatomists, women
will follow the fashion. In the words of Kipling :

1 For the colonel's lady and Judy O'Grady
Are both the same woman under their skins.'

At the present moment corsets are much better
made as to shape than they used to be. Tight lacing
is not good for the skin, not only about the waist but
for the complexion also, interfering as it does with
a proper circulation.

As to gloves, when they are tight and too small,
the circulation is interfered with. In the early
sixteenth century, gloves were much in vogue for
fear of infection.

In connexion with the subject of clothing, it may
be stated here that feather beds are not good for
the skin and should be taboo.

CHAPTER VII

SOAPS

A GREAT deal has been written about soaps.
Judging from the vast number of advertise-
ments that constantly meet the eye this might well
be called the l Soap Age/ Soaps with wonderful
names are born day by day. Many of them are no
doubt re-christened and are old friends with a new
label. Some are designed for washing clothes or
scrubbing floors, but they are apt to find their way
to the human skin, with unpleasant results at times,
in children for instance. A number of medicated
soaps are constantly put on the market, but as a rule
their therapeutic action is more or less illusory, in
many cases at any rate. It is well to beware of the
bland names which sometimes cover products that
may be irritating. They are apt to be a delusion and
a snare. But when people are selling goods, they
are not always over-scrupulous. Most of them have
never read Ruskin's 'Unto this Last/ and his notion of
what ideally a commercial man should be. Caveat
emptor or ' Let the buyer beware ' is as true now as
ever it was. Moreover, some soaps are made with
inferior materials and a variety of waste products,
but they may be put up in an elegant way, and thus

72

SOAPS 73

mislead. To cover any deficiencies they are scented,
but not usually with essential oils from actual flowers,
for that would be expensive. The scents used are
mainly synthetic and made from tar products, like
so many of our dyes and flavourings.

The origin of soap is no doubt of great antiquity.
But as far as our own European history is concerned,
the Greeks appear to have obtained their soap from
the Gauls. The Greeks had various colonies on the
shores of the Mediterranean, the most flourishing
being Sicily, Naples, and Marseilles. The last named
place has been noted for centuries for its soap. The
Greek word for soap, sdpon (o-aTrwv), is said to be
of Celtic (Gaul) or of Northern origin. Pliny, the
Latin naturalist, who perished in the eruption of
Vesuvius 79 A.D., says that soap (sapo of the Romans)
was an invention of the Gauls, who made it from
goat-fat and lixiviated beech-ashes. He refers to
two sorts : soft and hard. The Gauls used it to
make their hair fair, he adds, and it was used by the
Germanic tribes ' more by the men than the women/
He alludes no doubt to the southern Gauls. From
Marseilles, the home of soap in the Western world,
its use spread to Greece and the other Greek colonies,
and later it came to be employed by the Romans. At
Pompeii, which was close to the old Greek colony of
Naples, there is a place where soap was made. The
remains of the building are between the street of the
Narcissi and the street of the Consul. Among the
Romans, from what Pliny says, soap appears to
have been a thick fluid or emulsion, made by mixing

74 THE HEALTH OF THE SKIN

olive oil with the water used to wash wood- ashes.
Marseilles soap and its congeners, Naples and Castille
soap, were made in this way. And the fact that it
was so made, that is from olive oil and wood- ashes
led to its great reputation down the centuries. The
great bulk of our soap is now made of animal fats
and chemicals. Some of the soaps on the market
are manufactured from rancid oils and various refuse
fatty materials of animal origin, which may make
them irritating to the skin. On the whole, however,
soaps are well made, but those made with pure olive
oil are still the best. In passing it may be said that
soft soaps are made with potash and hard ones with
soda. Later the Arabs added lime to soap which
rendered it more caustic. From the East, the re-
turning Crusaders brought soap home with them
apparently, but rather as a curiosity than a house-
hold necessity.

There is a passage in Jeremiah (ii. 22), in which the
word soap occurs, according to the translators, point-
ing to the fact that some kinds of whitewashing avail
not. ' For though thou wash thee with nitre, and
take thee much sope, yet thine iniquity is marked
before me, saith the Lord God.7

Superfatted soaps are those which contain
additional fat, that is in excess and beyond the
amount combined with the chemical parts in the
usual way of manufacture. Their effects are over-
estimated and the excess fat (uncombined) is apt to
become rancid. A bye-product in the making of
soap is glycerine, which is not a fat, but an alcohol

SOAPS 75

(triatomic), a fact not generally known, but it is not
recommended as a beverage on that account.

We have already alluded to the necessity of using
soap to remove dirt, and fatty and sweat products,
from the body, especially from the folds and clefts
of the body, where fermentation and decomposition
are more apt to occur and lead to irritant inflamma-
tory reactions in the skin.

To clean the skin generally, sponges and so forth
are used, but it is important that all such articles
should be thoroughly clean themselves. They be-
come soiled and greasy, and when in that condition
they do not help the skin. For cold sponging in
the morning tub, a sponge not used for soap and
warm water should be specially reserved. Loofah
friction and the rough towel are beneficial in the way
of stimulation of the skin and keeping it up to its
work, but smart rubbing in this way does not suit
everybody. Rubber sponges are not to be re-
commended for they get dirty and soiled.

CHAPTER VIII

COSMETICS OF THE SKIN

AS to the cosmetics of the skin, this is an art of
JLJL great antiquity, which has been practised in
the East from time immemorial. Jezebel of old
was painted, as were also the women of Babylon.
To describe the numerous fashions of Egypt, India,
China and Japan would take us too far. But as
regards the Western World, conquests and expan-
sions of the Greeks and Romans introduced many
of these customs from the Indus and the Nile to say
nothing of Asia Minor. All kinds of beautifying
lotions, unguents, dyes and scents were used as a
matter of course. If we consider the Latin satirical
poets alone, we find unending references to the
toilet preparations in use among the Roman empresses
and patrician women of their day. Ovid indeed
wrote a poem on the remedies and applications for
beautifying the female face. But for all the shafts
of satire directed against the abuse of cosmetics,
followed at a later period by the fulminations of
divines and moralists, the arts of painting the lily
and improving nature have gone on unchecked and
triumphant down to the present time. The impulse
towards ornamentation and the concealment of

76

COSMETICS OF THE SKIN 77

blemishes is so intimately connected with the funda-
mental sexual instincts, round which humanity re-
volves, that it is waste of time trying to put an end
to it. Learned professors may shake their heads
and prove beyond all manner of doubt that such
customs are bad, but they will always fail in their
endeavours, for women will ever strive to make
themselves attractive and make up for deficiencies
by a resort to art. And after all, cosmetics have
their place in life and may be properly employed
with advantage. Powders, lotions and creams, and
perfumes too, are necessary in the hygiene of the
skin. A good complexion, for instance, cannot be
attained without trouble. Everything depends on
the point of view of the individual concerned. Thus
exposure to strong cold winds or strong sunlight
may lead to an irritant and inflammatory condition
of the skin of the face. Here lotions and powders
are indicated. In bygone days masks were used
to shield the face from the sun. They originated
apparently in Italy. Shakespeare refers to this
mode in ' The Two Gentlemen of Verona ' :

* But since she did neglect her looking-glass
And threw her sun-expelling mask away
The air hath starv'd the roses in her cheeks.'

And again in ' Troilus and Cressida ' :

* My mask to defend my beauty.'

Apart from cleansing the skin and attention to
internal derangements, such as indigestion, chronic
constipation, inadequate liver and kidney action,

78 THE HEALTH OF THE SKIN

all conditions that react unfavourably on the skin,
leading to an unhealthy colour, spots and reddened
patches, there is certainly room for local applica-
tions. These depend on the texture and condition
of the skin, whether dry or greasy, coarse or thin,
complexion, colour of the hair, and other factors.
Treatment of a preventive kind requires discrimina-
tion. Where people go wrong is in using preparations
that do not suit their own particular case.

As to rouge, a certain amount applied in modera-
tion and carefully does not do any harm, unless the
reds are not well selected as to quality and origin.
In that case a permanent unhealthy sallowness ensues,
which calls for more and more rouging, a vicious
circle being established. Again, some toilet pre-
parations sold for beautifying the skin contain
metallic poisons. This occurs even when the pre-
paration is guaranteed to contain no ingredients of
that kind. When we consider the number of people
who have to make up for the stage, very little trouble
results from the application of pigments to the eye-
brows, eyelashes and the lips, provided always the
products are of good quality and carefully removed
secundum artem. In the old Greek days, there was
no necessity for make up as the actors wore masks,
for the words of a tragedy or comedy were of more
moment than the facial emotions. Applications for
beautifying the skin are mentioned in the Papyrus
Ebers, the oldest medical work of Egypt, which dates
from about 1500 years before Christ. For the
tint of the skin equal parts of honey, bicarbonate of

COSMETICS OF THE SKIN 79

soda and sea salt are recommended, and alabaster
powder added thereto for improving the body. In
the days of Nero, the toilet of a Roman patrician
lady was a very long and serious business, and as
many as two hundred slaves, usually Greek women,
were employed to administer to the requirements of
an Empress. There was an expert attendant for
every part of the toilet, one to apply the powder,
another to make up the complexion, white and red ;
others again to pencil the eyebrows, dress the hair,
clean the teeth, attend to the lips, hold the mirrors,
and polish the nails.

Patches or ' mouches ' were at one time much used.
In the seventeenth and eighteenth centuries it was
seriously discussed if a woman should wear more
than three. These black patches by contrast show
up the complexion. They were not only worn as
small circular black spots, but were of various
shapes : stars, half-moons and more elaborate
patterns. Pepys says in his ' Diary ' : ' My wife
seemed very pretty to-day, it being the first time
I had given her leave to weare a black patch/ At
the French court, they were called coquine, precieuse,
friponne, assassine, etc.

Massage of the skin as after the Turkish bath or the
Aix and Vichy douche, followed if possible by a cold
plunge is beneficial. But there is a lot of nonsense
talked about the enormous amount of dirt that is
got rid of in that way. Massage again is as a rule
badly done in Turkish baths. There is really no
need for the violence some rubbers employ. Very

8o THE HEALTH OF THE SKIN

gentle massage is often more beneficial than forceful
rubbing. In Japan, this is done by the blind, who
have lost their sight through small-pox in many cases.
In the Sandwich Islands, delicate massage is carried
out by the natives, what time they croon soft lullabies.
It is called ' lumilumi ' there. Massage is really an
art, requiring cultivated hands working with a re-
fined brain. The idea that any one can do massage
is a fallacy. The art requires training and know-
ledge. When we come to massage of the face and
scalp, we are soon landed over the borderland into
the realms of the fantastic. Both procedures are
valuable when properly carried out in suitable cases,
but when accompanied by the brass band of adver-
tisements which promise the impossible, it is well
to ponder. In passing it should be pointed out that
the slippers which pass from feet to feet in Turkish
baths should be constantly sterilized by dry heat.

In recent times, injecting paraffin under the skin
to fill in hollows and remedy malformations, of the
bridge of the nose for instance, has been resorted to,
but a note of warning is necessary here. The im-
mediate results may appear satisfactory, but dread-
ful deformities due to deep ulceration about the face
have ultimately occurred in a good many recorded
instances. In one case that came under my own
care in which this paraffin injection had been done
on the Continent in the region of the neck some time
previously, large glands formed due to infection and
the patient went to pieces as a result*

CHAPTER IX

THE HAIR

DRESSING the hair was perhaps the principal
part of the toilet, as it is now. On ancient
monuments the hair played an important part as
in the curled Assyrians. Among the Greek women
there was an extraordinary variety of fashion, as
displayed on Greek vase paintings, in statues and
in the terra-cotta figures of Tanagra. In that huge
museum of Naples, the various fashions in hair
dressing can be well seen in the statues and busts of
Roman women. But it must not be forgotten that
many of the Roman Empresses and patricians wore
blonde wigs, the hair being imported from Gaul and
Britain. Fair, auburn or red hair was preferred.
In the frescoes discovered recently in the excava-
tions of the old Minotaurian Palace of Knossos in
Crete, the arrangement of the hair was so modern,
that a French archaeologist exclaimed when he was
shown them ' Mais ce sont des parisiennes.' Beauti-
ful ivory, gold, silver and bronze hair-pins were used.
Such have been discovered ; together with bronze-
combs, pomatum-boxes, mirrors, and so forth,
artistically decorated, in the ruins of Pompeii. Dye-
ing the hair was common too. In the East for

82 THE HEALTH OF THE SKIN

centuries, vegetable dyes such as henna (khenna)
and indigo have been employed for tinting in various
shades. Henna produces a deep orange or auburn
colour. The Persians dye the whole of the hands
as far as the wrists with it and also the soles of the
feet. The Turks more usually tinge the nails. In
North Africa, henna is also rubbed into the finger
tips and feet, and with good reason no doubt for it
is astringent in its action. Some preparations are
sold under the name of henna, which are composed
of chemicals ; such may be harmful. The much
admired Venetian red in the paintings of the old
masters was artificial. A recipe for dyeing the hair
a fine gold in the time of Leonardo da Vinci was as
follows : — Maize juice, decoction of chestnut, saffron,
ox bile, ambergris, calcined bears' claws and oil of
tortoise. Incidentally I may mention here a prepa-
ration for sunburn and pimples of the same period : —
Asses' milk mixed with the milk of a red goat,
asparagus ends and white lily bulbs. This was to
be rubbed into the face whilst the lady recited a
short prayer three times in succession. The make-up
of Caterina Sforza was made by mixing two and a
half ounces of carbonate of lead with an equal
quantity of tartrate of potash, and adding five
ounces of a compound of corrosive sublimate and
silver and some tragacanth and Sari powder. This
was then placed in the abdominal cavity of a Pisan
pigeon after carefully gutting the bird and cleansing
with spring water. The next step was to cook the
bird thus stuffed in a saucepan containing water that

THE HAIR 83

had been used to make an infusion of adder. The
remedy was applied at bed-time. They evidently
had plenty of time on hand in those days and quaint
notions. The latest thing is blue, green and scarlet
wigs for fancy dress balls, no doubt merely a revival
of what has obtained in the past, if we are to believe
Ecclesiastes, and that there is nothing new under
the sun.

But to return to colouring of the hair, dyes nowa-
days are chemical. Usually two solutions have to
be used to obtain the desired effect. In an ordinary
way, these solutions are metallic as to one of them at
any rate, the other being a ' mordant ' or fixation
fluid. More recently owing to the wonders of syn-
thetic chemistry, which can play marvellous varia-
tions on the tar series, dyes are frequently of this
origin. These, arid the others too, may lead to wide-
spread irritant inflammations of the skin of the acute
eczema type, with swelling and redness of the scalp,
face and orbits. I have seen several instances of
these complications. In one the eczema-like trouble
was very intense and rapidly spread from the head
and face to the finger-tips. The fact is that some
of these modern hair-dyes are two-edged swords
and dangerous. They may have been used by an
individual before without mishap perhaps, but one
fine day severe inflammation of the skin results
from the application. Peroxide of hydrogen is well
known, but its use is frequently much overdone, with
the result that it makes the hair brittle, dull in look,
and inaesthetic. Tibullus, a Latin poet, in one of

84 THE HEALTH OF THE SKIN

his elegies alludes to the use of the juice of the green
shell of the walnut to dye the hair and thus conceal
the ravages of time.

Sometimes very inflammable fluids are used for
cleaning the head and hair. This has led to serious
burns in women terminating fatally, for as already
said the shock from burns about the head is extreme.
Ordinary motor petrol is sometimes foolishly used
in this way and fatal accidents have been recorded.
Not only is the petrol itself highly inflammable, but
its volatile fumes also, so that a naked light or a
match or a lighted cigar or cigarette may ignite it
at a distance, with dire results. This happens too
through carelessness in handling petrol in garages.
Yet I have heard of the children of thoughtless parents
being allowed to play with petrol in a bathroom
as if it were tap water. Celluloid combs as orna-
ments for the hair are dangerous for the same reason,
for celluloid is extremely inflammable and may lead
to bad burns. Nor should celluloid collars and cuffs
be worn on the same grounds. All celluloid goods
should be sold in wrappers marked in large red
letters: 'Inflammable/ Celluloid it must be remem-
bered is chiefly made of gun-cotton. Celluloid toys,
such as bouncing balls, etc., should not be given to
children. Celluloid eye-shades I consider dangerous.

Another body, carbon tetrachloride, a heavy vola-
tile and mobile chloroform- like liquid with a pleasant
pungent quince-like odour was largely used until
recently by hairdressers as a substitute for petroleum
as a dry shampoo. It is dangerous and should not

THE HAIR 85

be used. The death of a lady was reported in the
papers as a result of the inhalation of the vapour
whilst she was being shampooed. I believe the use
of carbon tetrachloride has been given up. In any
case it is well to mention this occurrence in this place
and to say further that dry shampooing is not gener-
ally to be recommended. It is astonishing in my
experience how casually these dangerous prepara-
tions are employed in hairdressing. Strong potash
and formalin preparations are also sometimes used
in a happy-go-lucky way.

Just as there are only thirty-six dramatic situations,
women through the ages have rung the changes on a
more or less fixed number of ways of putting up the
hair. Fashions in this come and go, but they are
not new. Powdering the hair used to be much in
vogue in the eighteenth century, and fine houses
had their powdering room. Now this mode only
survives in the gorgeous flunkeys of some of the
great, for the fashion even here is dying out, no
doubt as a result of the advent of the motor-car.

As to loss of hair, precocious in man, or as a result
of chronic seborrhoea, treatment requires to be
adapted to the individual case ; there is no penny-in-
the-slot method of dealing with such cases.

Again, the hair may fall out as a result of various
morbid conditions and infections, debility, severe
illnesses, and so forth. These causes must be dis-
entangled before any line of treatment can possibly
give any result. The top hat has been made re-
sponsible for baldness, but antique busts not infre-

86 THE HEALTH OF THE SKIN

quently represent the bald, Socrates, for instance.
Excessive brain-work has also been brought forward
as a cause, but there are plenty of bald men about,
who have not as much brain as a healthy rabbit.
Other excesses have been made to play a part. On
the other hand, an excellent head of hair may go with
excessive activities in many directions.

In the scalp, the hair may also come out commenc-
ing with small bald circular patches, which by running
into one another may denude the head to a great
extent or occur as a band of baldness round it. In
severe cases, all the hair of the head may fall out and
then the eyebrows and eyelashes start coming out,
as well as the hair in other parts. The nails may be
affected too in some of these cases. Such conditions
require careful investigation. Unfortunately there
is nothing in the way of prevention that can be
recommended. In these cases again, the hair when it
grows again is apt to be white, at first at any rate,
and take on the ordinary colour of the hair after a
time.

Various general diseases affect the scalp locally and
lead to bare and sometimes scarred areas that require
general treatment. Sudden blanching of the hair
has been recorded, but such an occurrence is very
open to doubt. In some instances, as during the
French Revolutionary period, the blanching in the
prisons was due to the fact that the individuals had
no access to their hair-dye.

In children, ringworm of the scalp is one of the
most troublesome contagious diseases we have to deal

THE HAIR 87

with in London. It is due to a microscopic fungus, a
minute plant, which grows down the hair tube. It is
this that makes it so difficult to cure. At school-age,
it means the loss of months of school- work and socially
therefore it is of the utmost importance. Education
so-called being compulsory, every child practically
runs the risk in our board schools of getting ring-
worm. Prevention here is of value. All children
of school-age, attending primary schools especially,
should wear the hair short and their head should be
thoroughly shampooed once a week. If parents
would see to this a great deal could be done in the
way of stamping out the disease, but many parents
are so poor and so hunted about by all sorts of
authorities, that they become indifferent from sheer
want of energy and as a result of malnutrition, some
of them living under conditions that are a disgrace
to our much vaunted civilization. I have found
that persuasion answers much better than forceful
measures with penalties attached to them. Children
at school should be warned too as to wearing one
another's caps. Some forms of ringworm are con-
tracted from domestic pets, cats, dogs, horses, as are
also other diseases by the way. Children should not
fondle animals over much, if at all, and certainly not
allow them to lick their mouth and face.

In ringworm of the head, immediately a patch is
discovered, the hair should be all cut off short or
if possible shaved and the cap or headgear lined with
tissue paper tacked in, the paper being burnt every
night. Old linings should be torn out and burnt,

88 THE HEAXTH OF THE SKIN

or the hats and cap.; sacrificed. Care as to any other
children in the family and house is essential. In this
way much might be done as to prevention and spread
to other parts of the scalp or to other children. It is
no use dabbing on iodine or using ointments in a
half-hearted and futile manner as is usually done.
The scalp condition must be first definitely diagnosed
and treated thoroughly and with energy, according
to the conditions obtaining in any particular district.

Much of what has been said of ringworm might be
said of ' nits/ These might be avoided, if the same
precautions we have just mentioned were taken as to
the insect getting from one head to the other in the
first place. Our school-board system is not fair to
those parents, who are careful about their children
and are cleanly. Here the social problem of poverty
and dirt crops up again. If details as to ringworm
and nits were taught in our schools, instead of a
great deal of useless stuff, such demonstrations would
interest the children. As it is the weird answers
given in examinations point to the chaos that
exists in the mind of the youngsters.

Ringworm of the skin, apart from the scalp, can
be readily dealt with and cured. As to some forms,
the Eastern or Dhobie itch variety, it is the well-to-
do who suffer, in spite of baths and exceptional
cleanliness, and these forms are not always easy to
get rid of, especially in some situations.

The hairy parts and the body generally are liable to
be invaded by animal parasites, and this may happen
accidentally to people who are frequently washing

THE HAiR 89

themselves and using plenty of soap and water. Among
the Arabs shaving is resorted to no doubt to cut the
ground from uncjer the feet of the undesirable guests.
The old Greek statues of women show that epilation
was the rule. The epilators in Roman days were
very expert in removing superfluous hairs and used
beautiful forceps for that purpose, which can be seen
at the British Museum. But epilation needs to be
done repeatedly as the hairs grow again. In order
to avoid the trouble of epilation, various powders
and applications have been devised from very early
times, and especially in the East. Such a one is
Rusma, which under various fancy names appears in
advertisements of the present day. They contain
arsenic, but other chemical preparations are also
employed. Here again, the hairs are not perman-
ently destroyed. The only way of achieving this is
by electrolysis, and this requires to be well done to
get any result. The X-rays are not to be recom-
mended though they appeared some years ago to be
just the thing that was wanted. But the complica-
tions in the way of disfigurement about the lips and
chin especially have shelved them for this purpose.
The hair should not be washed too frequently,
but the intervals depend very much on the occupa-
tion, dust from roads in dry weather, smuts and
dirt from the atmosphere as in fogs, the greasiness
of the scalp and the amount of perspiration. Some
kind of soap is usually necessary to get the head and
hair clean. Many of the powders sold for shampoo-
ing are fairly reliable, but egg emulsions, being

go THE HEALTH OF THE SKIN

organic and liable to go wrong, are not recommended.
Besides, eggs are not always above suspicion. It is
easy too to cover the aroma of none too fresh eggs
with some strong scent or other, especially as such
emulsions are not likely to be held up to the nose
before use.

The prevalent idea that frequent cutting of the
hair is good for growth is more or less of a super-
stition, and the same may be said of singeing the ends
and of the electric treatment of the scalp, whatever
that treatment may mean. I have seen a number of
people now, who had had all this kind of thing done
with no result whatever.

As to the so-called Marcel waving, which was
probably practised in the days of King Minos of old
Crete, this is beneficial in some cases, provided that
it is done with care and gentleness and not with
unnecessary violence. The tongs must not be too
hot either. Curling tongs were used by the Romans.
Tight hair-curlers that drag on the hair all night are
not recommended, nor are stiff metallic or whalebone
brushes. It is important that the hair, where it is
long, should have freedom and ventilation at in-
tervals, and this is very advisable when toupets,
wigs and pads are worn, especially when the wigs
have strong springs. It is not a good thing for wigs
to pass from head to head, though in these present
days of fancy dress and masquerading mania this is
lost sight of.

In hairdressers' shops, the counsel of perfection
would be to sterilize hair brushes and shaving brushes

THE HAIR 91

by dry heat, and to use alcohol for cleaning cutting
instruments. The shaving brush does far more
mischief than the razor, though it is the latter
that is usually accused of being the culprit.
When the face is cut accidentally, stopping the
bleeding by means of the solid stick passing from
face to face should not be allowed by the cus-
tomer. Infections may occur in this way, some-
times serious.

Clippers are very handy and quickly remove the
hair at the back of the head and about the neck,
but they are not recommended. They are not
always easy instruments to put together again when
taken to pieces for cleaning, and for that reason they
are but too often not cleaned at all.

The revolving hair-brush should have been given
up long ago, and sterilized hand brushes used instead.
The former is often in a dirty condition and passes
from poll to poll without any attempt at cleansing
or sterilization. To refuse the use of the aforesaid
interesting mechanism requires great firmness, for
the barber is a very autocratic person when he gets
your head and face in his hands. I have watched
with intense interest the look of pain, not unmixed
with scorn, that passes over the features of Figaro
when such aids are declined, with or without thanks.
As to the revolving brush it is bad for the operator
himself, for the rapid revolutions of the brush throw
up a cloud of minute bits of hair into his mouth and
lungs. In conclusion, hair-dressing saloons should
be run on aseptic lines as far as possible. And this

92 THE HEALTH OF THE SKIN

is in the interests of the hairdresser as well as of the
customers. Such establishments are very few and
far between in London, strange as it may seem.
Strict aseptic methods cannot be carried out, that
would be too much to expect, for it is difficult
to make the lay mind grasp the underlying prin-
ciples. At times, the operator will drop the brush,
comb or scissors on the floor. In such a case,
fresh sterilized and clean instruments should be
used and the soiled ones put on one side for clean-
ing and sterilizing.

Many men plaster their hair down with sticky
messes of various kinds, which are certainly not good
for the scalp and hair. Some of these preparations
are made up of organic materials, such as honey.
In the old days ' pomatum ' was much used and
' bear's grease ' was also in vogue, so much so that
barbers used to advertise the fact of the purchase of
a bear in order that there might be no mistake about
the grease being the real thing. The origin of the
anti-macassar was to prevent soiling the arm-
chairs by oiled and be-pomaded heads. And in the
more primitive walks of life, a horizontal grease-line
was an additional ornament to the bewildering
wall-papers from the habit of leaning the head
against the wall whilst balancing the body on a
chair. All such greases, owing especially to their
liability to become rancid, are not good for general
use.

As to the eyebrows, we have already referred to
pencilling. Various preparations of lamp-black in

THE HAIR 93

sticks are used for this purpose. Kohol, a black
sulphide of antimony, is employed in the East for the
eyebrows and eyelashes. This is a common fashion
in Egypt and dates from remote times. In the
eighteenth century a dye called Teinture chinoise
and also sold under the name of Kohol was in vogue
and is still on the market.

CHAPTER X

TATTOOING

"OEFORE leaving the subject of ornamentation,
JD we may here allude to the fashion of tattooing,
which obtains among some native races, as the
Maories of New Zealand, for instance, who decorate
their face with complicated linear and circular
patterns. In India, some of these tattoo-marks are
indicative of caste, such as the vermilion spot in
the centre of the forehead. In the days of cannibal-
ism, tattooing served to distinguish the victors'
friends. As Hazlitt puts it : ' The unenlightened
savage makes a meal of his enemy's flesh, after re-
proaching him with the name of his tribe, because
he is differently tattooed.1 Among the Japanese,
tattooing is a fine art, taking the form of polychrome
snakes, dragons, and so forth. Some of these are
extremely well done, and Europeans visiting the
country succumb to the temptation of these elaborate
designs. Tattooing is usual among soldiers and
sailors. In prisons tattoo-marks are common. Many
of these are however very crude, unless they have
been done by an Eastern artist. ' I love Mary/ or
in the case of women ' I love Jack/ are not unusual,
but the trouble arises when the man marries Susan

94

TATTOOING 95

and the woman takes Charlie unto herself. The
point I desire to bring out is that sometimes a serious
contagious malady has been inoculated in this way
when the operator has used dirty instruments and,
what is worse, his own saliva. Tattoo-marks are
very difficult to remove. It is out of the question
when large surfaces are involved, and even in the case
of small designs the results do not amount to much
as a rule, though various methods are employed.
To achieve anything like a result, time, trouble and
perseverance are necessary.

CHAPTER XI

THE NAILS

WE must now refer to the nails. They are
structures that are correlated with the hair
and teeth, and in some morbid conditions when the
general nutrition is affected they may all suffer
together. The nails grow forward from the matrix,
starting under the nail-fold, over the upper surface
of the finger-ends or nail-beds. A blunt, flat instru-
ment can be pushed under the nail fairly readily
until the convex part of the half-moon is reached,
where the nail is fixed to the underlying parts. After
illnesses, transverse furrows may appear indicative
of the indisposition, especially on the thumb-nails
and the left more usually than the right. In delicate
individuals chiefly, white spots may appear in the
nails due to air imprisoned between the layers of
horny substance that build up the nail-plate or as
a result of injuries at the nail- fold. Longitudinal
ribbing of the nails is very marked in some individuals
and is usually put down to goutiness, why, I do not
know. Goutiness means so many thing. The fact
is the nail grows in a ribbed manner, which is normally
not very obvious, but may become so in disturbances
of health or with age. Combined with this, a wavy

THE NAILS 97

appearance may be observed. Or the nail may be
spooned, that is depressed into a hollow on its
surface. Again, the nails are in some people very
brittle, and break and shell off when pared. This
is often associated with brittle hair and indifferent
or bad teeth, showing deficiencies in the general
condition and in the chemical constituents of the
body. Some general skin diseases affect the nails,
pitting them on the surface or undermining them at
their edges. Or the nail-bed may be specially affected
and the nail-plates themselves raised by excessive
growth of the tissues beneath. The nails again may
become claw-like, greatly elongated and sometimes
twisted like horns. Or they may be thin and soft,
or greatly thickened, dirty and unsightly. This is
mainly observed about the toe-nails. That painful
condition known as ingrowing toe-nail may be
mentioned here in passing ; this is usually due to
inattention to their periodical cutting and trimming.
Ringworm may affect the nails, both of the fingers
and toes. It is a very intractable condition to treat
and in some cases may go on for years without being
diagnosed as such, for it may require a prolonged
microscopical examination to find the parasitic
fungus. The growth of the nails is slow, but in some
subjects they may occasionally grow more quickly
than usual. Treatment of the nails requires much
perseverance and takes time. In the new-born the
^ nails grow more slowly than at later periods.

The nails may suffer in some constitutional diseases,
and then constitutional treatment is necessary, local

98 THE HEALTH OF THE SKIN

applications being insufficient. The nails are abnor-
mally arched and curved from behind forwards in
consumption, and the finger-ends may be enlarged
too, ' the clubbed fingers/ A drum-stick appear-
ance is observed in some congenital heart conditions.
When the finger end has been damaged or partly
removed in one way or the other, an attempt at
growing a nail of sorts may manifest itself in the
stump. The nails are transparent, that is why in
good health they appear rosy, but in anaemia for
instance, owing to the condition of the blood, this
pinkness gives way to pallor. Where the circula-
tion is poor, the colour may be bluish. This occurs
too when people suffer from cold or after prolonged
bathing in cold water, being very marked in indi-
viduals with a poor circulation. In conditions of
malnutrition, the nails may become soft.

In all ages the nails have received much atten-
tion from the point of view of cosmetics and nowa-
days manicuring is usual. But with regard to this
it should be borne in mind, that manicures as also
chiropodists and corn-cutters, should see that their
instruments are always clean and sterilized. This
is not usually the case. Accidental infections have
occurred owing to negligence in this way, especially
as regards corns. In the old days of Rome, the
manicuring slave and chiropodist was an indispens-
able person in the toilet-chamber of patrician women
as we have already incidentally stated, not only for
the hands but for the feet as well in that sandal-
wearing age. In a novel by Petronius, who lived

THE NAILS 99

at the time of Nero (about 60 A.D.), in the course of
a description of the feast given by Trimalchio, a rich
and uneducated upstart, an allusion is made to the
attendants who ' pedicured ' the feet of the guests.

Among the Chinese, very long finger-nails are a sign
of aristocracy and power. And so long are the nails,
that special and expensive protectors are worn to pre-
vent their being injured. Some of the Fakirs of the
East make vows never to cut the nails, which grow
to inordinate lengths and are said in some cases when
the hands are kept clenched to grow into the palms.
Benvenuto Cellini during his imprisonment in the
castle of St. Angelo, found that his uncut nails gave
him much pain and torment. In his ' Memoirs ' he
says they grew to such an immoderate length that
he could not touch himself without being cut by
them ; nor could he put on his clothes, because they
pricked and gave him the most exquisite pain.

Some individuals of neurotic tendencies have a
bad habit of biting the nails constantly or sucking
their thumbs, like the old Egyptian god Horus.
Needless to say that children should be broken off this
early in life. It is not nice to begin with and more-
over it leads to deformity of the nails. In days
gone by, biting one's thumb at somebody was con-
sidered an insult. The passage in ' Romeo and
Juliet ' : — ' I will bite my thumb at them ; which is
a disgrace to them if they bear it ' will occur to
readers.

The nails should be attended to regularly and kept
clean, for finger-nails in ' deep-mourning ' are not a

ioo THE HEALTH OF THE SKIN

pretty sight. Those who use their hands should
wear the nails short and circular at the free ends.
Long, pointed nails are all very well for those who
have nothing to do and who become slaves to their
nails and to manicuring. There are other things in
this world besides nail-cutting and polishing the
finger-ends. Those who have good half-moons
should push the nail-folds back from time to time
with a small blunt ivory instrument for that purpose
and not a sharp metallic one. Cleanliness with
soap and a nail-brush, with a little occasional polish-
ing with a pad, is all that is necessary in the ordinary
way. Strong solutions for dipping the finger-ends
in during the process of manicuring sometimes lead
to inflammation. In the language of manicurists,
the margin of skin at the nail-fold is called the cuticle ;
— small curved scissors should be used for removing
irregularities. But once more all instruments should
be thoroughly cleansed and wiped in suitable fluids
after use to avoid possible troubles. New emery-
boards again should be used for each person and
then thrown away. The rule is for emery-boards to
be used for one person after the other until com-
pletely worn out. This is not good from the point
of view of the manicured. Lord Chesterfield, to
whom our great Samuel Johnson addressed his
famous letter, was very particular about the nails,
for he says : ' Nothing looks more ordinary, vulgar
and illiberall, than dirty hands and ugly, uneven
and ragged nails : the ends of which should be kept
smooth and clean (not tipped with black), and small

TIJE NAILS 101

segments of circles'; arid £very'tim6 thai^trie hands
are wiped, rub the skin round the nails backwards,
that it may not grow up, and shorten them too much.'
To preserve the nails and hands in various occu-
pations, as in amateur gardening, women should
wear suitable gloves. This is a counsel of perfec-
tion, for many people have to earn their living by
handling fluids and preparations, which interfere
with the quality and appearances of the nails.
Apart from those who use dyes and strong liquids
for cleaning purposes, such as French polishers and
others, I would mention here, in connexion with the
hands and nails, barmen and barmaids, grocers,
hairdressers, and bricklayers. Some of these in-
flammatory conditions of the fingers are popularly
alluded to as barmaid's and bricklayer's itch, but
they are not true itch, which is an irritating com-
plaint more generally distributed over the body
and due to a minute animal parasite. They are the
result of constant wetting of the hands behind the
bar and the irritation of mortar, lime and so forth
in building operations, the result being an inflam-
mation of an eczematous type. Again, gardeners are
liable to similar irritant skin troubles after handling
certain plants, such as Primula obconica, Rhus toxi-
codendron, and so forth. In the case of Primula
obconica and Chinese primula, the inflammatory
skin trouble is due to a poisonous substance secreted
by the downy hairs about the plant. Fortunately
only certain individuals are susceptible, but those
who are may suffer again and again.

102 THE HEALTH OF THE SKIN

In arsenical poisoning, tne nails and hair, for
which arsenic has a selective affinity, reveal the
drug on analysis. This fact is important from the
medico-legal point of view. In this connexion it
may be added, that in the beer-poisoning epidemic
in Manchester some years ago, due to the fact that
the glucose used for brewing purposes was made
with impure sulphuric acid, the skin symptoms
observed in many of the cases gave the clue to the
origin of the poisoning. The public are very prone
to gird at the medical profession, but it was the
medical man in this, as in many other obscure
maladies and epidemics, who put his finger on the
cause.

In this place, identification by finger-prints may
be alluded to. The surface of the skin generally is
thrown into minute ridges and valleys, but this is
most marked and obvious on the pulp of the finger-
ends where even with the naked eye ridges and
whorls can be readily made out. These patterns
vary from individual to individual, and this has led
to the identification of criminals leaving the imprint
of their finger-ends on paint-work or windows, some-
times blood-stained. Some of these whorls are very
beautiful and curious. It has occurred to me that
this may have been the origin of the custom of placing
the finger on the seal when executing a legal deed.
When people generally could not write, in the days
when knights were bold and barons held their sway,
the imprint of the finger-end on the soft wax (now
reduced to the symbolic red paper seal) would have

THE NAILS 103

been a record of the individual. This is mere sup-
position, I admit.

On the under or palmar surface of the fingers,
cross or transverse lines at the folds of the joints
will be noticed. From time immemorial these lines
have been used for purposes of identification by the
Chinese. In official documents and deeds, the im-
print of the inter-articular folds of the individual's
left index-finger are mapped out in Chinese or what
we call more usually Indian ink, and the length of
the finger-nail is added, together with the name of
the person in Chinese characters. The French have
adopted this method in their dealings with the
natives in Tonquin and Indo-China.

The sweat pores open out on the tops of the
ridges and not in the intervening valley-like depres-
sions we have described. In the excessive sweating
of the palms of the hands, this can be well made out
by means of a magnifying glass, for in this situation
the sweat orifices are very numerous, as sufferers
from sweating palms know but too well.

The feet have been dealt with incidentally in
other parts of this book. It is only necessary to add
here that they should be attended to from the point
of view of cleanliness as carefully as the hands.
Though it may not always be possible to get a full
bath, a foot-bath is generally obtainable.

LONDON, May 1914.

INDEX

ACARUS, 20, 21.

Acne rosacea, 40.

vulgaris, 39.

Acupuncture, 3.
Albinos, 16.
Anatomy, 5.
Artisans' Dwellings, 31.

BACK, the, 46.
Bagdad boil, 42.
Baldness, 34.
Barber's pole, 9.
Baths, 49.
Bedding, 71.
Birth-marks, 32.
Biskra button, 42.
Blackheads, 39.
Bleeders, 27.

Blood-vessels of the skin, 8.
Body-louse, the, 22.
Body- temperature, the, 28.
Boots and shoes, 69.
Branchial clefts, 26.
Breasts, the, 46.

CALLOSITIES, 29.

Chest, the, 46.

Cleavage, lines of, of the skin, 46.

Clothing, 65.

Collier de Vtnus, 45.

Colour of the skin, 16, 17, 29.

Corium, the, 7.

Corsets, 70.

Cosmetics, 76.

Counter-irritation, 3, 9.

Cupping, 9.

Cupping-dish, 9.

DEVELOPMENT of the skin, i.
H

EAR, the, and the skin, i.
Elastic, the, tissue of the skin, 18.
Electric-belts, 14.
Electric-eel, 13.
Electricity and the skin, 14.
Epidermis, the, 5.

and the teeth, 7.

Eye, the, and the skin, i, 4.
Eyebrows, the, 36, 92.
Eyelashes, the, 36.

FACTORIES and Hygiene, 57.
Fat, the, under the skin, n, 28.
Feet, the, 47, 62, 103.
Finger-prints, identification by,

IO2.

Fleas, 25.

and the plague, 24.

Freckling, 30.

GARTERS and gartering, 69.
Gloves, 71.

HAIR, the, 81.

colour of the, 16, 83.

racial variations in the, 16.

Hair-dyes, 82.

dangers of, 83.

Hairdressers' shops, hygiene of,

9?, 91.
Hairs, ii.
Hairy people, 16.
Hands, the, 62, 101, 103.
Harvest-bug, the, 22.
Hats, 68.
Hygiene, general, 49.

lONIZATION, 15.

Itch, the, 20.

105

io6

HEALTH OF THE SKIN

JAIL-FEVER, 24.
Jaundice, 18.

KISSING, the dangers of promis-
cuous, 25.

LEECHES, 9.

Leprosy, 18, 26.

Lice, 22.

Lips, the, 43, 44.

Lupus erythematosus, 41.

vulgaris, 40.

MALARIA and mosquitoes, 24.
Malformations, 27.
Manicuring, TOO.
Marcel-waving, 90.
Masque, let de la grossesse, 45.
Massage, 61, 79.
Mites, 20, 21, 22.
Moles, 32.
Mosquitoes, 24.

NAILS, the, 96.

Neck, the, 45.

Nerves of the skin, 10.

Nervous symptoms and the skin,

i, 19, 26.
Nettle-rash, 25.
New-born, the, 62, 63, 65.
Nits, 23, 24.
Nose, the, 42.
red, 42, 43.

ODOUR of sanctity, 17.

Odours, the, of the skin, 17, 53,

5.4, 55-
Opium, 20.

PALMS, the, 47.

Paraffin injections under skin, 80.
Parasites and the hair, 88, 89.
Patches or ' mouches,' 79.

Physiology of skin, 5.
Physiological variations, 16.
Pigmentation of the skin, 18.
Pigmented patches of Japanese

babies, 17.

Plague, the, and fleas, 24.
Platysma, the, muscle, 45.
Possession, demoniac, 25.

RINGWORM of the scalp, 86, 87,

88.

Ringworm of the skin, 88.
Rouge, 78.

SAILOR'S skin, 30.

Scalp, the, 35, 86.

Scents, 56.

Sebaceous, the, glands, n.

Secondary sexual characters, 37.

Shedding of the skin, 6.

Shingles, 47.

Skin, the, as an organ of sense, 2.

Skin-grafting, 13.

Sleeping sickness, 24.

Slums, vertical, 31.

Small-pox, 30.

Soaps, 72.

Sponges, 75.

Stockings and socks, 69.

Sun-rays, the, 30, 31, 38.

TATTOOING, 94.
Torpedo fish, 13.

and gout, 14.

Tramps, 24.

Typhus fever and lice, 24.

VENESECTION, 9.
Ventilation, 53.
Vitality of the skin, 13.

X-RAYS, 32.
YELLOW-FEVER, 24.

Printed by T. and A. CONSTABLE, Printers to His Majesty
at the Edinburgh University Press

Methuen's Shilling Library

36 De Profundis Oscar Wilde

37 Lord Arthur Savile's Crime Oscar Wilde

38 Selected Poems Oscar Wilde

39 An Ideal Husband Oscar Wilde

40 Intentions Oscar Wilde

41 Lady Windermere's Fan Oscar Wilde

42 Charmides and other Poems Oscar Wilde

43 Harvest Home E. V. Lucas

44 A Little of Everything E. V. Lucas

45 Vailima Letters Robert Louis Stevenson

46 Hills and the Sea H. Belloc

47 The Blue Bird Maurice Maeterlinck

48 Mary Magdalene Maurice Maeterlinck

49 Under Five Reigns Lady Dorothy Nevill

50 Charles Dickens G. K. Chesterton

51 Man and the Universe Sir Oliver Lodge
*52 The Life of Robert Louis Stevenson Graham Balfour

53 Letters from a Self -Made Merchant to his Son

George Horace Lorimer

*54 The Life of John Ruskin W. G. Collingwood

55 The Parish Clerk P. H. Ditchfield

56 The Condition of England C. F. G. Masterman

57 Sevastopol and other Stories Leo Tolstoy

58 The Lore of the Honey- Bee Tickner Edwardes

59 Tennyson A. C. Benson
*6o From Midshipman to Field Marshal Sir Evelyn Wood

62 John Boyes, King of the Wa-Kikuyu John Boyes

63 Oscar Wilde Arthur Ransome

64 The Vicar of Morwenstow S. Baring-Gould

65 Old Country Life S. Baring-Gould

66 Thomas Henry Huxley P. Chalmers Mitchell
*67 Chitral Sir G. S. Robertson

68 Two Admirals Admiral John Moresby

76 Home Life in France M. Betham-Edwards

77 Selected Prose Oscar Wilde

78 The Best of Lamb E. V. Lucas
80 Selected Letters Robert Louis Stevenson
83 Reason and Belief Sir Oliver Lodge
85 The Importance of Being Earnest Oscar Wilde
88 The Tower of London Richard Davey
9 1 Social Evils and their Remedy Leo Tolstoy

93 The Substance of Faith Sir Oliver Lodge

94 All Things Considered G. K. Chesterton

95 The Mirror of the Sea Joseph Conrad

96 A Picked Company Hilaire Belloc
10 1 A Book of Famous Wits Walter Jerrold
1 16 The Survival of Man Sir Oliver Lodge

1 26 Science from an Easy Chair Sir Ray Lankester

* Slightly Abridged.

Methuen & Co., Ltd. 36 Essex Street, London, W.C.

Methuen's Shilling Novels

1 The Mighty Atom

2 Jane

3 Boy

4 Spanish Gold

5 The Search Party

6 Teresa of Watling Street

7 Anna of the Five Towns

8 Fire in Stubble

9 The Unofficial Honeymoon
10 The Botor Chaperon

Marie Corelli
Marie Corelli
Marie Corelli
G. A. Birmingham
G. A. Birmingham
Arnold Bennett
Arnold Bennett
Baroness Orczy
DolfWyllarde
C. N. and A. M. Williamson

1 1 Lady Betty across the Water C. N. and A. M. Williamson

12 The Demon C. N. and A. M. Williamson

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19 Under the Red Robe

20 Light Freights

21 The Gate of the Desert

22 The Long Road

23 The Missing Delora

24 Mirage

71 The Gates of Wrath

72 Short Cruises

73 The Pathway of the Pioneer
75 The Street Called Straight
8 1 The Card

84 The Sea Lady

86 The Wild Olive

87 Lalage's Lovers

90 A Change in the Cabinet
92 White Fang
97 A Nine Days' Wonder
99 The Coil of Carne
too The Mess Deck

1 02 The Beloved Enemy

103 The Quest of the Golden Rose

104 A Counsel of Perfection

1 06 The Wedding Day

107 The Lantern Bearers

1 08 The Adventures of Dr. W bitty

109 The Sea Captain

no The Babes in the Wood
in The Remington Sentence

112 My Danish Sweetheart

113 Lavender and Old Lace

1 14 The Ware Case

115 Old Rose and Silver

117 The Secret Agent

118 My Husband and I

1 19 Set in Silver

120 A Weaver of Webs

121 Peggy of the Bartons

Robert Hichens
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Sir A. Conan Doyle
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E. Maria Albanesi
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C. N. and A. M. Williamson
Mrs Alfred Sidgwick
G. A. Birmingham
H. C. Bailey
B. M. Croker
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W. Clark Russell
Myrtle Reed
George Pleydell
Myrtle Reed
Joseph Conrad
Leo Tolstoy

C. N. and A. M. Williamson
John Oxenham
B. M. Croker

122 The Double Life of Mr. Alfred Burton £. Phillips Oppenheim

123 There was a Crooked Man DolfWyllarde

124 The Governor of England Marjorie Bowen

125 The Regent Arnold Bennett

127 Sally D. Conyers

128 The Call of the Blood Robert Hichens

129 The Lodger Mrs. Belloc Lowndes

UNIVERSITY OF CALIFORNIA LIBRARY
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